Provider Demographics
NPI:1063728905
Name:SQUIRE, CHAD ALLEN (DPM)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ALLEN
Last Name:SQUIRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 S MAIN ST UNIT B203
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5585
Mailing Address - Country:US
Mailing Address - Phone:928-457-0961
Mailing Address - Fax:928-457-0929
Practice Address - Street 1:932 S MAIN ST UNIT B203
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5585
Practice Address - Country:US
Practice Address - Phone:928-414-1280
Practice Address - Fax:928-414-1280
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ875213ES0103X
NM353213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty