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NPI Code Detail

MEDICARE: MR. CHAD MICHAEL LIBBY A.T.C.

MEDICARE: MR. CHAD MICHAEL LIBBY A.T.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer00273IA

General Provider Information

NPI Number : 1053391904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHAD MICHAEL LIBBY A.T.C.
Provider Business Mailing Address
First Line : 702 TIPPERARY RD
Second Line :
City : IOWA CITY
State : IA
Zip : 52246-2791
Country : US
Telephone Number : 319-337-2764
Fax Number : 319-399-8721
Provider Business Practice Location Address
First Line : 1220 1ST AVE NE
Second Line : COE COLLEGE, EBY FIELDHOUSE
City : CEDAR RAPIDS
State : IA
Zip : 52402-5008
Country : US
Telephone Number : 319-399-8014
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/08/2007

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