Provider Demographics
NPI:1316425960
Name:QUEEN, CHAD WILLIAM (DC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:WILLIAM
Last Name:QUEEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 W TENUTA ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3216
Mailing Address - Country:US
Mailing Address - Phone:702-241-5346
Mailing Address - Fax:
Practice Address - Street 1:3088 W TENUTA ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3216
Practice Address - Country:US
Practice Address - Phone:702-241-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor