Individual
CHASE EDWARD TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 E COLISEUM BLVD, FORT WAYNE, IN 46805
(260) 481-6656
(260) 481-0291
Mailing address
2144 POINT WEST DR APT 2A, FORT WAYNE, IN 46808-4259
(785) 766-4333
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003070A
IN
Other
Enumeration date
09/07/2018
Last updated
09/07/2018
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