Provider Demographics
NPI:1982367140
Name:KNIGHT, CHASE
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NE YELLOW PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-6176
Mailing Address - Country:US
Mailing Address - Phone:850-779-7280
Mailing Address - Fax:
Practice Address - Street 1:140 NE YELLOW PINE AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-6176
Practice Address - Country:US
Practice Address - Phone:850-779-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date: