Provider Demographics
NPI:1700547536
Name:LIGHTFOOT, CHASE DEAN
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:DEAN
Last Name:LIGHTFOOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 PLEASANT COLONY CT
Mailing Address - Street 2:STE 1
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8679
Mailing Address - Country:US
Mailing Address - Phone:502-727-7803
Mailing Address - Fax:
Practice Address - Street 1:6003 PLEASANT COLONY CT
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8678
Practice Address - Country:US
Practice Address - Phone:502-243-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor