Provider Demographics
NPI:1366115636
Name:NEWKIRK, CHANCE
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:
Last Name:NEWKIRK
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 1:1615 E COUNTY ROAD 400 N
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-6750
Mailing Address - Country:US
Mailing Address - Phone:812-525-5635
Mailing Address - Fax:
Practice Address - Street 1:1615 E COUNTY ROAD 400 N
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-6750
Practice Address - Country:US
Practice Address - Phone:812-525-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine