Provider Demographics
NPI:1548039217
Name:ROBINSON, CHANCE MICHAEL
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:MICHAEL
Last Name:ROBINSON
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 1:804 FREEPORT AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2447
Mailing Address - Country:US
Mailing Address - Phone:763-441-3930
Mailing Address - Fax:
Practice Address - Street 1:804 FREEPORT AVE NW STE A
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2447
Practice Address - Country:US
Practice Address - Phone:763-441-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist