Individual
NICOLAS CHACE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7274 WARDLEIGH RD BAY J, HILL AIR FORCE BASE, UT 84056-5137
(435) 757-6142
Mailing address
1264 HEBER AVE, POCATELLO, ID 83202-5087
(435) 757-6142
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT750
ID
Other
Enumeration date
09/23/2014
Last updated
12/16/2023
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