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1588106785 NPI number — CHELSEY BACA ATC, LAT

NPI Number: 1588106785
Health Care Provider/Practitioner: CHELSEY BACA ATC, LAT

Information about “1588106785” NPI (CHELSEY BACA ATC, LAT) exists in 1588106785 in HTML format HTML  |  1588106785 in plain Text format TXT  |  1588106785 in PDF (Portable Document Format) PDF  |  1588106785 in an XML format XML  formats.

NPI Number : 1588106785 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588106785",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BACA",
    "FirstName": "CHELSEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC, LAT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "17374 N 89TH AVE APT 1326",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85382-8139",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-703-3194",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9126 W CAMELBACK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENDALE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85305-3116",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-703-3194",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/06/2016",
    "LastUpdateDate": "11/06/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "2000022761",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "1426",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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