Healthcare Provider Details

I. General information

NPI: 1457560898
Provider Name (Legal Business Name): CHAD ALLEN CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD # 2-641 BLVD #2-641
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

15599 W MACKENZIE DR
GOODYEAR AZ
85395-7779
US

V. Phone/Fax

Practice location:
  • Phone: 855-864-4322
  • Fax:
Mailing address:
  • Phone: 480-201-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number1326
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: