Healthcare Provider Details

I. General information

NPI: 1801371414
Provider Name (Legal Business Name): CHAD KRUMPHOLZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAIN ST # 4126
NASHUA NH
03060-2913
US

IV. Provider business mailing address

221 MAIN ST # 4126
NASHUA NH
03060-2913
US

V. Phone/Fax

Practice location:
  • Phone: 720-689-3550
  • Fax:
Mailing address:
  • Phone: 720-689-3550
  • Fax: 720-815-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12793
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3620
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007468
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0007468
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: