Healthcare Provider Details

I. General information

NPI: 1295413656
Provider Name (Legal Business Name): CHRISTOPHER CALVIN EILBER LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S 1300 E
SALT LAKE CITY UT
84105-3617
US

IV. Provider business mailing address

1352 E MCCORMICK WAY
COTTONWOOD HEIGHTS UT
84121-4707
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-7651
  • Fax:
Mailing address:
  • Phone: 801-244-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number12968700-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: