Healthcare Provider Details

I. General information

NPI: 1366760555
Provider Name (Legal Business Name): CHAD S GABBARD ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 COLD SPRING RD
INDIANAPOLIS IN
46222-1960
US

IV. Provider business mailing address

8389 BARSTOW DR
FISHERS IN
46038-4444
US

V. Phone/Fax

Practice location:
  • Phone: 317-209-6820
  • Fax:
Mailing address:
  • Phone: 317-955-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001077A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number36001077A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: