Healthcare Provider Details

I. General information

NPI: 1700921624
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL LUDWIG A.T.,C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 TRENTON AVE
CLOVIS CA
93619-5065
US

IV. Provider business mailing address

201 N BLOSSOM RD
WATERFORD CA
95386-9651
US

V. Phone/Fax

Practice location:
  • Phone: 209-606-9424
  • Fax:
Mailing address:
  • Phone: 209-606-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: