Healthcare Provider Details

I. General information

NPI: 1922154384
Provider Name (Legal Business Name): CHAUNCEY BELSER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 3RD ST STE 1
CHIPLEY FL
32428-1855
US

IV. Provider business mailing address

877 3RD ST STE 1
CHIPLEY FL
32428-1855
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-8447
  • Fax: 850-638-9217
Mailing address:
  • Phone: 850-638-8447
  • Fax: 850-638-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number00139
License Number StateFL

VIII. Authorized Official

Name: MR. CHAUNCEY L BELSER
Title or Position: OWNER
Credential:
Phone: 850-526-3067