Provider Demographics
NPI:1194781633
Name:CHICHESTER, DAN L (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:L
Last Name:CHICHESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E 3900 S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1228
Mailing Address - Country:US
Mailing Address - Phone:801-268-8222
Mailing Address - Fax:801-268-9926
Practice Address - Street 1:1140 E 3900 S
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1228
Practice Address - Country:US
Practice Address - Phone:801-268-8222
Practice Address - Fax:801-268-9926
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT164813-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD26484Medicare UPIN
UT005775501Medicare ID - Type Unspecified