MEDICARE: NICOLAS CHACE ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT750	ID

General Provider Information

NPI Number	:	1073915864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAS CHACE ANDERSON

Provider Business Mailing Address
First Line	:	1264 HEBER AVE
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83202-5087
Country	:	US
Telephone Number	:	435-757-6142
Fax Number	:

Provider Business Practice Location Address
First Line	:	7274 WARDLEIGH RD BAY J
Second Line	:
City	:	HILL AIR FORCE BASE
State	:	UT
Zip	:	84056-5137
Country	:	US
Telephone Number	:	435-757-6142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	12/16/2023

Similar Medicare Providers

1255614848 — JESSICA LYNN TOWNSEND ATC
Practice Location Address:

7274 WARDLEIGH RD BAY J
HILL AFB, UT
84056-5137

Practice Phone: 248-561-8834
Practice Fax:

1235567298 — VISIONWORKS, INC
Practice Location Address:

1201 N HILL FIELD RD , #2046
LAYTON, UT
84041-5137

Practice Phone: 801-444-7200
Practice Fax: 801-444-3098

1083094981 — STU BECHTLER
Practice Location Address:

261 MUCHADO HILL RD
ALTON, NH
03809-5137

Practice Phone: 419-564-6306
Practice Fax:

1962261735 — CIERA ANGELA MINTZ
Practice Location Address:

5137 PANTHER DR
SPRING HILL, FL
34607-2402

Practice Phone: 126-758-6844
Practice Fax:

1982681292 — MR. RICKIE E. JOHNSON PA
Practice Location Address:

7238 6TH ST BLDG 249
HILL AIR FORCE BASE, UT
84056-5213

Practice Phone: 801-777-1155
Practice Fax: 801-775-6884

1083672992 — GARY HEASTON PA-C
Practice Location Address:

7238 6TH ST , JENSEN OCCUPATIONAL MEDICINE CENTER, BLDG. 249
HILL AIR FORCE BASE, UT
84056-5213

Practice Phone: 801-777-1157
Practice Fax:

Directions to “ NICOLAS CHACE ANDERSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.