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NPI Code Detail

MEDICARE: DEON DOBSON ATC

MEDICARE: DEON DOBSON ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1407122039
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEON DOBSON ATC
Provider Business Mailing Address
First Line : 7306 S WINCHESTER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60636-3738
Country : US
Telephone Number : 773-517-8618
Fax Number :
Provider Business Practice Location Address
First Line : 205 W WACKER DR STE 1020
Second Line :
City : CHICAGO
State : IL
Zip : 60606-1452
Country : US
Telephone Number : 312-423-3200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2012
Last Update Date : 03/28/2012

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Directions to “ DEON DOBSON ATC” Practice Location

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