Provider Demographics
NPI:1750789970
Name:CHARTRAND, DAVID (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:CHARTRAND
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 COLORADO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2008
Mailing Address - Country:US
Mailing Address - Phone:719-582-1614
Mailing Address - Fax:719-924-9359
Practice Address - Street 1:509 COLORADO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2008
Practice Address - Country:US
Practice Address - Phone:719-582-1614
Practice Address - Fax:719-924-9359
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHAD. 0000159237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist