Individual
MR. CHADDRICK LENDON JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10651 E ST, CORPUS CHRISTI, TX 78419-5130
(361) 961-2688
Mailing address
10651 E ST, CORPUS CHRISTI, TX 78419-5130
(361) 961-2688
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
1710I1002X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
INDEPENDENT DUTY CORPSMAN
TX
Enumeration date
03/23/2006
Last updated
02/06/2008
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