Healthcare Provider Details

I. General information

NPI: 1679480313
Provider Name (Legal Business Name): MICHAEL JASON CHANDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N GLADEVIEW DR
FARMINGTON NM
87401-6067
US

IV. Provider business mailing address

801 N GLADEVIEW DR
FARMINGTON NM
87401-6067
US

V. Phone/Fax

Practice location:
  • Phone: 505-402-8601
  • Fax:
Mailing address:
  • Phone: 505-402-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: