Healthcare Provider Details

I. General information

NPI: 1063728905
Provider Name (Legal Business Name): CHAD ALLEN SQUIRE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 S MAIN ST UNIT B203
SNOWFLAKE AZ
85937-5585
US

IV. Provider business mailing address

932 S MAIN ST UNIT B203
SNOWFLAKE AZ
85937-5585
US

V. Phone/Fax

Practice location:
  • Phone: 928-414-1280
  • Fax: 928-414-1280
Mailing address:
  • Phone: 928-457-0961
  • Fax: 928-457-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number353
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00875
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: