Provider Demographics
NPI:1144693300
Name:CHIA, INNOCENT
Entity type:Individual
Prefix:
First Name:INNOCENT
Middle Name:
Last Name:CHIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-8828
Mailing Address - Country:US
Mailing Address - Phone:630-901-8400
Mailing Address - Fax:
Practice Address - Street 1:1021 RESERVE DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-8828
Practice Address - Country:US
Practice Address - Phone:630-901-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC000-4067-0101343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)