Provider Demographics
NPI:1730461138
Name:MULLINS, CHAD N
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:N
Last Name:MULLINS
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 1:513 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:SC
Mailing Address - Zip Code:29055-1219
Mailing Address - Country:US
Mailing Address - Phone:704-970-8237
Mailing Address - Fax:
Practice Address - Street 1:513 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:SC
Practice Address - Zip Code:29055-1219
Practice Address - Country:US
Practice Address - Phone:704-970-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter