Provider Demographics
NPI:1750587234
Name:CHANCE, MARK L (FA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:CHANCE
Suffix:
Gender:M
Credentials:FA
Other - Prefix:
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Mailing Address - Street 1:15242 W.82ND TERR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219
Mailing Address - Country:US
Mailing Address - Phone:913-541-1228
Mailing Address - Fax:913-439-1942
Practice Address - Street 1:15242 W 82ND TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1501
Practice Address - Country:US
Practice Address - Phone:913-541-1228
Practice Address - Fax:913-439-1942
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist