1467751552 NPI number — MR. CHASE MICHAEL PAULSON MS, ATC

Table of content: MR. CHASE MICHAEL PAULSON MS, ATC (NPI 1467751552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467751552 NPI number — MR. CHASE MICHAEL PAULSON MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAULSON
Provider First Name:
CHASE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467751552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2007 WINDEMERE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91784-7903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-917-3578
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21400 PATHFINDER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIAMOND BAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91765-2747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-594-1405
Provider Business Practice Location Address Fax Number:
909-595-8301
Provider Enumeration Date:
03/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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