Healthcare Provider Details

I. General information

NPI: 1083170542
Provider Name (Legal Business Name): CHRISTOPHER PRATT MECHERLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W SOUTH ST
CLINTON IL
61727-2103
US

IV. Provider business mailing address

3208 BRENNAN LN
BLOOMINGTON IL
61704-2752
US

V. Phone/Fax

Practice location:
  • Phone: 217-937-5224
  • Fax:
Mailing address:
  • Phone: 309-838-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: