Individual
CHRIS BRIAN LOPEZ DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
155 RADIO DR, WOODBURY, MN 55125-2619
(952) 831-8742
Mailing address
18423 97TH PL N, MAPLE GROVE, MN 55311-7708
(320) 291-3569
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3500
MN
Other
Enumeration date
11/29/2024
Last updated
11/29/2024
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