Individual
CHASE MADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
725 POLE LINE RD W, TWIN FALLS, ID 83301-5800
(208) 814-1600
(208) 814-1910
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
PA-2346
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/28/2014
Last updated
07/01/2025
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