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Individual

SHANE M CHIASSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
726 N ACADIA RD, THIBODAUX, LA 70301-5051
(985) 493-4502
Mailing address
162 HARVEST CT, THIBODAUX, LA 70301-3988

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.200421
LA

Other

Enumeration date
07/01/2020
Last updated
07/01/2020
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