Healthcare Provider Details

I. General information

NPI: 1871190876
Provider Name (Legal Business Name): CHASE HOLLANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S VINE ST
DENVER CO
80210-5264
US

IV. Provider business mailing address

2905 INCA ST UNIT 1087
DENVER CO
80202-1954
US

V. Phone/Fax

Practice location:
  • Phone: 737-248-0210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: