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General NPI Number Information
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NPI Number | 1932576535
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Entity Type | Individual
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Provider Name | EDWARD SCEEREY MS, ATC, CES, OTC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 2633 S. LOWE AVE
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-533-0546
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Fax |
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Provider Business Mailing Address
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Address Line | 2633 S. LOWE AVE
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 09604404
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License Number State | IL
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