Provider Demographics
NPI:1427739937
Name:CHANDLER, JAMIE MICHEAL
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHEAL
Last Name:CHANDLER
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 1:164 COUNTRY COURT CIR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9778
Mailing Address - Country:US
Mailing Address - Phone:859-433-0493
Mailing Address - Fax:
Practice Address - Street 1:164 COUNTRY COURT CIR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-9778
Practice Address - Country:US
Practice Address - Phone:859-433-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist