Healthcare Provider Details

I. General information

NPI: 1912653270
Provider Name (Legal Business Name): CHANCE RUMMLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 FIR ST
OAK HILLS CA
92344-9505
US

IV. Provider business mailing address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1302
US

V. Phone/Fax

Practice location:
  • Phone: 714-916-6871
  • Fax:
Mailing address:
  • Phone: 850-883-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number81651-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: