Basic Information
| Provider Information | |||||||||
| NPI: | 1528445319 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CHANCELLOR | ||||||||
| FirstName: | ALLISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 SAUNDERSVILLE RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370758903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | 8555404722 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 PROFESSIONAL DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620025067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184657177 | ||||||||
| FaxNumber: | 6184657176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2015 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 085.005448 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207LP2900X | 085005448 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.