Healthcare Provider Details

I. General information

NPI: 1215117585
Provider Name (Legal Business Name): DAVID S. CHESS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S RIDGEWOOD AVE UNIT D
EDGEWATER FL
32141-4227
US

IV. Provider business mailing address

930 S RIDGEWOOD AVE
EDGEWATER FL
32132-2331
US

V. Phone/Fax

Practice location:
  • Phone: 386-423-3100
  • Fax: 386-423-3102
Mailing address:
  • Phone: 386-423-3100
  • Fax: 386-423-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHESS
Title or Position: PRESIDENT
Credential:
Phone: 386-423-3100