Individual
CHASE JACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1055 N 500 W STE 121, BLDG C, PROVO, UT 84604-3305
(801) 373-7350
(801) 812-5401
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14246720-1206
UT
Other
Enumeration date
05/13/2024
Last updated
10/10/2025
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