Individual
MR. BENJAMIN CHAZ CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAT, LAT, ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46808
(920) 619-0184
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46808
(920) 619-0184
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002726A
IN
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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