Provider Demographics
NPI:1538864251
Name:CHANCLER, JULIE LYNN
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:CHANCLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:TX
Mailing Address - Zip Code:78343-2820
Mailing Address - Country:US
Mailing Address - Phone:128-181-3161
Mailing Address - Fax:
Practice Address - Street 1:6200 SARATOGA BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3478
Practice Address - Country:US
Practice Address - Phone:361-717-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist