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General NPI Number Information
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NPI Number | 1063728905
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Entity Type | Individual
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Provider Name | CHAD ALLEN SQUIRE DPM
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Gender | Male
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 932 S MAIN ST UNIT B203
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City | SNOWFLAKE
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State | AZ
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Zip | 85937-5585
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Country | US
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Telephone | 928-414-1280
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Fax | 928-414-1280
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Provider Business Mailing Address
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Address Line | 932 S MAIN ST UNIT B203
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City | SNOWFLAKE
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State | AZ
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Zip | 85937-5585
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Country | US
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Telephone | 928-457-0961
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Fax | 928-457-0929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 353
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 00875
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 875
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License Number State | AZ
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