Healthcare Provider Details

I. General information

NPI: 1962666255
Provider Name (Legal Business Name): CATHY CHASE CA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 ATWOOD AVE SUITE 105
MADISON WI
53704-6622
US

IV. Provider business mailing address

2045 ATWOOD AVE SUITE 105
MADISON WI
53704-6622
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-5080
  • Fax: 608-661-0489
Mailing address:
  • Phone: 608-256-5080
  • Fax: 608-661-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number330-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: