Individual
JASYN SCOTT CHIDESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
180 EL CAMINO REAL, SUITE M384, OFFICE 229, PALO ALTO, CA 94304
(650) 885-6300
Mailing address
4003 CHEENEY ST, SANTA CLARA, CA 95054-2522
(650) 504-0048
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000025880
BOC CERTIFIED ATHLETIC TRAINER
—
Enumeration date
05/04/2017
Last updated
02/01/2018
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