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General NPI Number Information
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NPI Number | 1366576670
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Entity Type | Individual
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Provider Name | ALLAN CHASE MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 102 MERCURY DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-9650
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Country | US
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Telephone | 217-363-5205
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 JEFFREY DR
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City | RANTOUL
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State | IL
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Zip | 61866-1705
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Country | US
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Telephone | 815-302-9577
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL2023
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT3267
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT001604
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATH.200358
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License Number State | LA
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Taxonomy #6
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096002191
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License Number State | IL
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