Healthcare Provider Details

I. General information

NPI: 1285091207
Provider Name (Legal Business Name): JORDAN CHAUSSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 RIVERSIDE DR SUITE 1
LEBANON NH
03766-2033
US

IV. Provider business mailing address

81 RIVERSIDE DR SUITE 1
LEBANON NH
03766-2033
US

V. Phone/Fax

Practice location:
  • Phone: 603-443-9639
  • Fax: 603-443-9659
Mailing address:
  • Phone: 603-443-9639
  • Fax: 603-443-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number647013
License Number StateNH

VIII. Authorized Official

Name: THERESA CHAUSSE
Title or Position: OWNER
Credential:
Phone: 603-443-9639