Individual
JESSE CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
2501 N BLACKWELDER AVE, OKLAHOMA CITY, OK 73106-1402
(405) 208-6500
Mailing address
2601 N KENTUCKY AVE APT 413, OKLAHOMA CITY, OK 73106-1282
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
722
OK
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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