| Doctor Name: | DR. CHADWICK J SHADE |
| NPI Number: | 1255658860 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PSY0091 |
| Business Practice Address: | 5955 Zeamer Avenue 3rd Mdg Elmendorf Afb, AK - 99506 |
| Business Phone Number: | 9075802181 |
| Business Fax Number: | |
| Mailing Address: | 5955 Zeamer Avenue, 3rd Mdg ELMENDORF AFB |
| State: | AK |
| Postal Code: | 99506 |
| Phone Number: | 9075802181 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2010 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY0091 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |