Provider Demographics
NPI:1124081617
Name:CHANCE, CHERYL GAYE (LO CO)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:GAYE
Last Name:CHANCE
Suffix:
Gender:F
Credentials:LO CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 CALDER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1410
Mailing Address - Country:US
Mailing Address - Phone:409-833-8600
Mailing Address - Fax:409-833-8605
Practice Address - Street 1:3195 CALDER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1410
Practice Address - Country:US
Practice Address - Phone:409-833-8600
Practice Address - Fax:409-833-8605
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531812OtherBLUE CROSS BLUE SHIELD
TX21919OtherCHOICE 1 UTMB HEALTHCARE
TX10018181OtherAMERIGROUP MANAGED CARE
TX4867530001Medicare ID - Type Unspecified