Healthcare Provider Details

I. General information

NPI: 1861413841
Provider Name (Legal Business Name): CHESTER ALLEN COON M.S., ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

IV. Provider business mailing address

3708 W MERRYWOOD LN
MUNCIE IN
47302-9186
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-7738
  • Fax:
Mailing address:
  • Phone: 765-760-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001060A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: