Healthcare Provider Details

I. General information

NPI: 1013842111
Provider Name (Legal Business Name): MR. DENNIS CHANDLER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 LA MESA AVE
SHASTA LAKE CA
96019-9210
US

IV. Provider business mailing address

3929 LA MESA AVE
SHASTA LAKE CA
96019-9210
US

V. Phone/Fax

Practice location:
  • Phone: 530-510-2448
  • Fax:
Mailing address:
  • Phone: 530-510-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: