Provider Demographics
NPI:1932210580
Name:WHEELER, CHAD KENNEDY (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:KENNEDY
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1316
Mailing Address - Country:US
Mailing Address - Phone:509-321-6033
Mailing Address - Fax:509-232-0003
Practice Address - Street 1:530 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1316
Practice Address - Country:US
Practice Address - Phone:509-321-6033
Practice Address - Fax:509-232-0003
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008126208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery