Provider Demographics
NPI:1962779801
Name:CHASE, MARY ELISABETH (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELISABETH
Last Name:CHASE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 HIGHWAY 121 BYP N STE B
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8759
Mailing Address - Country:US
Mailing Address - Phone:270-971-4344
Mailing Address - Fax:
Practice Address - Street 1:1601 HIGHWAY 121 BYP N STE B
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8759
Practice Address - Country:US
Practice Address - Phone:270-971-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5328111N00000X
TN2554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100290840Medicaid