# MR. CHAD P ENICH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1174510879
- **Gender:** Man
- **Credential:** PA C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 146N00000X | Basic Emergency Medical Technician | 001165 | IA | — |
| 207Q00000X | Family Medicine Physician | 01165 | IA | — |
| 363A00000X | Physician Assistant | 001165 | IA | Yes |

## Other

- **Enumeration date:** 09/29/2005
- **Last updated:** 05/24/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1174510879 | — | IA |
| 05 | — | 2133348 | — | IA |
| 01 | — | 44593 | BCBS | — |
| 01 | — | 970009403 | RAILROAD MEDICARE | IA |
| 01 | — | P01396066 | RR MEDICARE | IA |