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NPI Code Detail

MEDICARE: JORDAN CARTER CHVATAL

MEDICARE: JORDAN CARTER CHVATAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1417564097
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN CARTER CHVATAL
Provider Business Mailing Address
First Line : 819 TARA PLAZA
Second Line :
City : PAPILLION
State : NE
Zip : 68046
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 819 TARA PLZ
Second Line :
City : PAPILLION
State : NE
Zip : 68046-2043
Country : US
Telephone Number : 402-512-4296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2020
Last Update Date : 09/28/2020

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Directions to “ JORDAN CARTER CHVATAL ” Practice Location

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