Healthcare Provider Details

I. General information

NPI: 1376466839
Provider Name (Legal Business Name): AIDAN BRYCE CHICOSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SPRING GARDEN ST
GREENSBORO NC
27412-5015
US

IV. Provider business mailing address

306 WILTSHIRE DR
JAMESTOWN NC
27282-9729
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-5000
  • Fax:
Mailing address:
  • Phone: 336-848-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: