Provider Demographics
NPI:1801479555
Name:CHASE, JILL (RD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 BOOT HILL CT STE 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7248
Mailing Address - Country:US
Mailing Address - Phone:406-579-4994
Mailing Address - Fax:
Practice Address - Street 1:2246 BOOT HILL CT STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7248
Practice Address - Country:US
Practice Address - Phone:406-579-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-97434133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered