MEDICARE: DR. JOHN GERALD CHASE APRN, CNP, DC

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
1	111N00000X	Chiropractor	B00876	NV
2	111N00000X	Chiropractor	7122	AZ
3	363LF0000X	Family Nurse Practitioner	CNP4373	MN
4	111N00000X	Chiropractor	5653	MN

General Provider Information

NPI Number	:	1487661203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GERALD CHASE APRN, CNP, DC

Provider Business Mailing Address
First Line	:	PO BOX 547
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-0547
Country	:	US
Telephone Number	:	218-862-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 MEMORY LANE
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515
Country	:	US
Telephone Number	:	218-862-4325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	03/17/2018

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