Healthcare Provider Details

I. General information

NPI: 1235522863
Provider Name (Legal Business Name): CHRISTOPHER ANDERSON MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 ST RD 28
TIPTON IN
46072
US

IV. Provider business mailing address

5769 W 100 N
TIPTON IN
46072-8503
US

V. Phone/Fax

Practice location:
  • Phone: 765-437-8310
  • Fax:
Mailing address:
  • Phone: 765-437-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5632
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002121A
License Number StateIN

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: