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General NPI Number Information
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NPI Number | 1710047196
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Entity Type | Organization
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Legal Business Name | CHASTAINS INC.
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 312 SAINT JOHNS WAY SUITE #2
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City | LEWISTON
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State | ID
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Zip | 83501-2451
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Country | US
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Telephone | 208-743-7766
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Fax | 208-746-9937
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Provider Business Mailing Address
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Address Line | 312 SAINT JOHNS WAY SUITE #2
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City | LEWISTON
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State | ID
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Zip | 83501-2451
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Country | US
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Telephone | 208-743-7766
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Fax | 208-746-9937
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Authorized Official
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Title or Position | OWNER
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Name | MR. JONATHAN M. AUER
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Credential | RPH
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Telephone | 208-743-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | DME124
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License Number State | ID
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