Provider Demographics
NPI:1770738288
Name:DAVID B. CHALFANT PC
Entity type:Organization
Organization Name:DAVID B. CHALFANT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHALFANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-482-2206
Mailing Address - Street 1:5931 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4401
Mailing Address - Country:US
Mailing Address - Phone:260-483-3964
Mailing Address - Fax:260-483-3964
Practice Address - Street 1:5931 STONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4401
Practice Address - Country:US
Practice Address - Phone:260-482-2206
Practice Address - Fax:260-483-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100103880Medicaid
IN4590738OtherAETNA
IN000000086190OtherANTHEM BC/BS
IN000000086190OtherANTHEM BC/BS
IN100103880Medicaid