Provider Demographics
NPI:1336246594
Name:CHANDLER, CURTIS DALE (MS)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:DALE
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 GARDINER LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1978
Mailing Address - Country:US
Mailing Address - Phone:502-456-9998
Mailing Address - Fax:502-456-9923
Practice Address - Street 1:1448 GARDINER LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1978
Practice Address - Country:US
Practice Address - Phone:502-456-9998
Practice Address - Fax:502-456-9923
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1977501Medicare PIN