Healthcare Provider Details

I. General information

NPI: 1003339771
Provider Name (Legal Business Name): CHELSEA DAVIS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PINAL AVE
ORCUTT CA
93455-5302
US

IV. Provider business mailing address

1682 CRESTVIEW CIR
SAN LUIS OBISPO CA
93401-6016
US

V. Phone/Fax

Practice location:
  • Phone: 201-310-2067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: