Provider Demographics
NPI:1528457694
Name:BARKSDALE, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BARKSDALE
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 1:11483 S KESTREL RISE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5006
Mailing Address - Country:US
Mailing Address - Phone:801-712-8018
Mailing Address - Fax:
Practice Address - Street 1:11483 S KESTREL RISE RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5006
Practice Address - Country:US
Practice Address - Phone:801-712-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies