Healthcare Provider Details

I. General information

NPI: 1891230561
Provider Name (Legal Business Name): CHAD EVERETT YENSEN M.A, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 STONERIDGE LN SUITE C
DUBLIN OH
43017-2288
US

IV. Provider business mailing address

3900 STONERIDGE LN SUITE C
DUBLIN OH
43017-2288
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-9324
  • Fax: 614-366-9339
Mailing address:
  • Phone: 614-366-9324
  • Fax: 614-366-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: