Healthcare Provider Details

I. General information

NPI: 1942616305
Provider Name (Legal Business Name): CHRISTINE MICHELLE HOFFMAN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 N 27TH ST
DECATUR IL
62526-2191
US

IV. Provider business mailing address

2122 N 27TH ST
DECATUR IL
62526-2191
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-4975
  • Fax: 217-423-4485
Mailing address:
  • Phone: 217-876-4975
  • Fax: 217-423-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: