Individual
LON PHILLIP CHANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2626 SHOUP DR, SAN DIEGO, CA 92110-4268
(757) 641-3994
Mailing address
2626 SHOUP DR, SAN DIEGO, CA 92110-4268
(757) 641-3994
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710-1002X
IDC
—
Enumeration date
05/09/2013
Last updated
05/09/2013
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