Healthcare Provider Details

I. General information

NPI: 1417848896
Provider Name (Legal Business Name): DAVEN LEE CHAGNON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HASTINGS RD
SPOKANE WA
99218-4901
US

IV. Provider business mailing address

7101 N EXCELL CT
SPOKANE WA
99208-4509
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax:
Mailing address:
  • Phone: 509-991-9457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: