Provider Demographics
NPI:1689569030
Name:CHAMBERLAIN, CODY ROSS
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:ROSS
Last Name:CHAMBERLAIN
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 1:1111 S WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-2715
Mailing Address - Country:US
Mailing Address - Phone:740-538-2298
Mailing Address - Fax:
Practice Address - Street 1:1111 S WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-2715
Practice Address - Country:US
Practice Address - Phone:740-538-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61444607175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist