Provider Demographics
NPI:1285051680
Name:CHANEY, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CHANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 IVEY LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1611
Mailing Address - Country:US
Mailing Address - Phone:618-985-2465
Mailing Address - Fax:
Practice Address - Street 1:1012 IVEY LN
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1611
Practice Address - Country:US
Practice Address - Phone:618-985-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-030247183500000X, 1835P1200X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835X0200XPharmacy Service ProvidersPharmacistOncology