Healthcare Provider Details

I. General information

NPI: 1629001854
Provider Name (Legal Business Name): CHANCE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STATE ST
MCCALL ID
83638-3704
US

IV. Provider business mailing address

PO BOX 9649
BOISE ID
83707-4649
US

V. Phone/Fax

Practice location:
  • Phone: 208-634-2221
  • Fax:
Mailing address:
  • Phone: 208-472-8127
  • Fax: 208-344-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL TRAUGHBER
Title or Position: OWNER
Credential: M.D.
Phone: 208-634-2221