Healthcare Provider Details

I. General information

NPI: 1578229761
Provider Name (Legal Business Name): CHRIS PERRIN MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHAMPIONS DRIVE SUITE 230
COLUMBIA MO
65211-0001
US

IV. Provider business mailing address

1 CHAMPIONS DR
COLUMBIA MO
65211-0001
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-3532
  • Fax:
Mailing address:
  • Phone: 573-882-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number2601001551
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2021046883
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: