Provider Demographics
NPI:1053140343
Name:ROSSER, CHASE CHAPMAN (STUDENT)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:CHAPMAN
Last Name:ROSSER
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-1101
Mailing Address - Country:US
Mailing Address - Phone:816-982-0766
Mailing Address - Fax:
Practice Address - Street 1:2611 S 27TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-1101
Practice Address - Country:US
Practice Address - Phone:816-982-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program