Individual
MR. MARK ALLEN CHISUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC LAT
Contact information
Practice address
237 GENOA AVENUE, LUBBOCK, TX 79416
(806) 742-5111
(806) 742-4265
Mailing address
237 GENOA AVE, LUBBOCK, TX 79416-1707
(806) 791-5178
(806) 742-4265
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATO692
TX
Other
Enumeration date
04/16/2007
Last updated
07/09/2007
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