Healthcare Provider Details

I. General information

NPI: 1114945151
Provider Name (Legal Business Name): CHRISTOPHER K. CRATER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W. COLLEGE AVENUE WNMU ATHLETIC DEPARTMENT
SILVER CITY NM
88062
US

IV. Provider business mailing address

PO BOX 677
SILVER CITY NM
88062-0677
US

V. Phone/Fax

Practice location:
  • Phone: 505-538-6236
  • Fax: 505-538-6163
Mailing address:
  • Phone: 505-313-0762
  • Fax: 505-538-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number303
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: