Healthcare Provider Details

I. General information

NPI: 1942427604
Provider Name (Legal Business Name): CHRISTOPHER JASON LIEUW MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: C JASON LIEUW MS, ATC

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 GILL COLISEUM
CORVALLIS OR
97331-8547
US

IV. Provider business mailing address

1619 SW 49TH ST APT 42
CORVALLIS OR
97333-3006
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-0935
  • Fax: 541-737-0864
Mailing address:
  • Phone: 650-302-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: