Provider Demographics
NPI:1194065151
Name:CHADWELL, ANTHONY K (HHP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:K
Last Name:CHADWELL
Suffix:
Gender:M
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S HIGHWAY 101
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2228
Mailing Address - Country:US
Mailing Address - Phone:858-792-0754
Mailing Address - Fax:
Practice Address - Street 1:437 S HIGHWAY 101
Practice Address - Street 2:SUITE 202
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2228
Practice Address - Country:US
Practice Address - Phone:858-792-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130436133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist