Provider Demographics
NPI:1386432144
Name:MCCOLLUM, CHASE MICHAEL
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:MICHAEL
Last Name:MCCOLLUM
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 1:10022 W GREENSPOINT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1581
Mailing Address - Country:US
Mailing Address - Phone:316-250-1573
Mailing Address - Fax:
Practice Address - Street 1:10022 W GREENSPOINT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1581
Practice Address - Country:US
Practice Address - Phone:316-250-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program