MEDICARE: DR. DANIEL LOUIS CHADWELL PH.D.

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	231H00000X	Audiologist	8471398-4104	UT
2	237600000X	Audiologist-Hearing Aid Fitter	8471398-4101	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8471398-4101	OTHER	UT	STATE OF UTAH LICENSE
2	186	OTHER	NE	LICENSE

General Provider Information

NPI Number	:	1982647145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL LOUIS CHADWELL PH.D.

Provider Business Mailing Address
First Line	:	2602 W 13400 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-5819
Country	:	US
Telephone Number	:	801-738-2065
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 W 12600 S
Second Line	:	INTERMOUNTAIN RIVERTON HOSPITAL
City	:	RIVERTON
State	:	UT
Zip	:	84065-7215
Country	:	US
Telephone Number	:	801-285-4633
Fax Number	:	402-943-5539

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/04/2014

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