Provider Demographics
NPI:1073713426
Name:CHADBURN, JENNIFER LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:CHADBURN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:915 COMMONWEALTH AVE
Mailing Address - Street 2:DEPARTMENT OF PHYSICAL EDUCATION RECREATION AND DANCE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1394
Mailing Address - Country:US
Mailing Address - Phone:617-358-1890
Mailing Address - Fax:617-358-3747
Practice Address - Street 1:915 COMMONWEALTH AVE
Practice Address - Street 2:DEPARTMENT OF PHYSICAL EDUCATION RECREATION AND DANCE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1394
Practice Address - Country:US
Practice Address - Phone:617-358-1890
Practice Address - Fax:617-358-3747
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer