Healthcare Provider Details

I. General information

NPI: 1679528152
Provider Name (Legal Business Name): CHRISTOPHER J EMRICK ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 NEW BERN AVE
RALEIGH NC
27610-1214
US

IV. Provider business mailing address

3009 NEW BERN AVE
RALEIGH NC
27610-1214
US

V. Phone/Fax

Practice location:
  • Phone: 919-232-5020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5237
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1860
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: