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General NPI Number Information
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NPI Number | 1285091207
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Entity Type | Organization
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Legal Business Name | JORDAN CHAUSSE LLC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 81 RIVERSIDE DR SUITE 1
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City | LEBANON
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State | NH
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Zip | 03766-2033
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Country | US
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Telephone | 603-443-9639
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Fax | 603-443-9659
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Provider Business Mailing Address
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Address Line | 81 RIVERSIDE DR SUITE 1
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City | LEBANON
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State | NH
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Zip | 03766-2033
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Country | US
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Telephone | 603-443-9639
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Fax | 603-443-9659
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Authorized Official
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Title or Position | OWNER
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Name | THERESA CHAUSSE
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Credential |
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Telephone | 603-443-9639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 647013
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License Number State | NH
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