Individual provider · NPI-1

Ethan Thomas Chavez, ATC

Specialist/Technologist, Athletic Trainer · Kansas City, KS

NPI number1336780584
StatusActive
Last updated in NPPESMay 4, 2023

Details

NPI
1336780584
Entity type
Individual (NPI-1)
Name
Ethan Thomas Chavez
Credential
ATC
Sex
Male
Sole proprietor
Yes
Enumeration date
Sep 30, 2019
Certification date
May 4, 2023
Last updated
May 4, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer328474LAYes

Practice location

7250 State Ave
Kansas City, KS 66112-3003

Phone 913-288-7511

Mailing address

2407 N Frankford Ave
Lubbock, TX 79416-9643

Other practice locations

2407 N Frankford Ave
Lubbock, TX 79416-9643

Phone 806-283-8100

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