Healthcare Provider Details

I. General information

NPI: 1770256067
Provider Name (Legal Business Name): CHANCE ARNOLD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2021
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MAPLE AVE STE 110
EVANSTON IL
60201-3134
US

IV. Provider business mailing address

1704 MAPLE AVE STE 110
EVANSTON IL
60201-3134
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax: 224-271-5556
Mailing address:
  • Phone: 630-933-1500
  • Fax: 224-271-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070027705
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: