NICOLAS CHACE ANDERSON

HILL AIR FORCE BASE, UT
NPI1073915864
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID  AT750)
Enumeration Date2014-09-23
Last Update Date2023-12-16
Business Address
NICOLAS CHACE ANDERSON
7274 WARDLEIGH RD BAY J
HILL AIR FORCE BASE, UT 84056-5137
Phone number: 435-757-6142
Mailing Address
NICOLAS CHACE ANDERSON
1264 HEBER AVE
POCATELLO, ID 83202-5087
Phone number: 435-757-6142