Basic Information
| Provider Information | |||||||||
| NPI: | 1588748909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEBORAH L CHADWICK, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1129 | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708742470 | ||||||||
| FaxNumber: | 9708747482 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 STAFFORD LN | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814163465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708748026 | ||||||||
| FaxNumber: | 9708745430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHADWICK | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9708748026 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 41117 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | CH663005 | 01 | CO | BCBS | OTHER | 32051026 | 05 | CO | MEDICAID |