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General NPI Number Information
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NPI Number | 1679953822
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Entity Type | Organization
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Legal Business Name | CHIROCHASE LLC
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 222 E BLACKSTOCK RD SUITE D
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City | SPARTANBURG
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State | SC
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Zip | 29301-2627
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Country | US
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Telephone | 864-574-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 222 E BLACKSTOCK RD SUITE D
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City | SPARTANBURG
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State | SC
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Zip | 29301-2627
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Country | US
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Telephone | 864-574-8881
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CHASE LEE FOWLER
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Credential | D.C.
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Telephone | 864-574-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4000
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License Number State | SC
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