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General NPI Number Information
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NPI Number | 1962055996
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Entity Type | Individual
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Provider Name | MICHAEL CHASTAIN ATC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 100 E NORMAL AVE
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4221
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Country | US
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Telephone | 660-785-7521
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Fax |
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Provider Business Mailing Address
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Address Line | 508 W LAHARPE ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-1856
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Country | US
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Telephone | 816-682-4995
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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 | 2018028111
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License Number State | MO
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