Provider Demographics
NPI: | 1932252293 |
---|---|
Name: | CHANCE, JOHN EDWARD (DC) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JOHN |
Middle Name: | EDWARD |
Last Name: | CHANCE |
Suffix: | |
Gender: | M |
Credentials: | DC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1903 NW TOPEKA BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | TOPEKA |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 66608-1826 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 785-234-0900 |
Mailing Address - Fax: | 785-234-5832 |
Practice Address - Street 1: | 1903 NW TOPEKA BLVD |
Practice Address - Street 2: | |
Practice Address - City: | TOPEKA |
Practice Address - State: | KS |
Practice Address - Zip Code: | 66608-1826 |
Practice Address - Country: | US |
Practice Address - Phone: | 785-234-0900 |
Practice Address - Fax: | 785-234-5832 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-19 |
Last Update Date: | 2019-11-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | CH3938 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 350048346 | Other | RR MEDICARE PROVIDER # |
KS | 431877921 | Other | TAX ID # |
KS | 0007402220 | Other | AETNA PROVIDER # |
KS | 0007402220 | Other | AETNA PROVIDER # |
KS | 060381 | Medicare ID - Type Unspecified | MEDICARE PROVIDER # |