Healthcare Provider Details

I. General information

NPI: 1912209727
Provider Name (Legal Business Name): DAVID OLIVER CHANDLER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 WAKE FOREST RD
WINSTON SALEM NC
27109-6000
US

IV. Provider business mailing address

PO BOX 7329
WINSTON SALEM NC
27109-6231
US

V. Phone/Fax

Practice location:
  • Phone: 336-758-3215
  • Fax: 336-758-6149
Mailing address:
  • Phone: 336-758-3215
  • Fax: 336-758-6149

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: