Provider Demographics
NPI:1366576670
Name:CHASE, ALLAN (MS, ATC)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:CHASE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:RANTOUL
Mailing Address - State:IL
Mailing Address - Zip Code:61866-1705
Mailing Address - Country:US
Mailing Address - Phone:815-302-9577
Mailing Address - Fax:
Practice Address - Street 1:102 MERCURY DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-9650
Practice Address - Country:US
Practice Address - Phone:217-363-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
FLAL20232255A2300X
TXAT32672255A2300X
GAAT0016042255A2300X
LAATH.2003582255A2300X
IL0960021912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer