Healthcare Provider Details

I. General information

NPI: 1730222506
Provider Name (Legal Business Name): JAMES LE ROY SCHAPEKAHM A.T.C., LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MESA GRANDE DR
LAS CRUCES NM
88011-6017
US

IV. Provider business mailing address

5071 EMERALD ST
LAS CRUCES NM
88012-0632
US

V. Phone/Fax

Practice location:
  • Phone: 505-527-9430
  • Fax:
Mailing address:
  • Phone: 505-644-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number174
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: