Individual
JEROME CHANDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S.
Contact information
Practice address
1145 W GRAND BLVD, DETROIT, MI 48208-2336
(313) 324-8900
Mailing address
1145 W GRAND BLVD, DETROIT, MI 48208-2336
(313) 324-8900
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA0823206
MICHIGAN DEPT. OF LARA
MI
Enumeration date
08/07/2014
Last updated
08/07/2014
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