Provider Demographics
NPI:1407835622
Name:CHASE, CHRISTOPHER ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:CHASE
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 1:1032 BOULEVARD
Mailing Address - Street 2:SUITE 1022
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-616-1361
Mailing Address - Fax:
Practice Address - Street 1:1032 BOULEVARD
Practice Address - Street 2:SUITE 1022
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1801
Practice Address - Country:US
Practice Address - Phone:860-616-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001904111N00000X
NJ38MC00522700111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ550846679OtherHORIZON BLUE CROSS BLUE SHIELD
NJ015075Medicare PIN