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Individual

CHANCELOR LUCAS HERNANDEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA, ATC, LAT

Contact information

Practice address
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(920) 219-4009
Mailing address
207 MONROE ST APT 9, BEAVER DAM, WI 53916-2475
(920) 382-7313

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1063-39
WI

Other

Enumeration date
06/05/2015
Last updated
06/05/2015
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