Provider Demographics
NPI:1285296293
Name:BALKMAN, CHANDLER JAMES (CPO)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:JAMES
Last Name:BALKMAN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 W WILLIAMS ST STE 104
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3955
Mailing Address - Country:US
Mailing Address - Phone:919-267-5284
Mailing Address - Fax:888-635-6138
Practice Address - Street 1:1031 W WILLIAMS ST STE 104
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3955
Practice Address - Country:US
Practice Address - Phone:919-267-5284
Practice Address - Fax:888-635-6138
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO04250222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist