Provider Demographics
NPI:1083170542
Name:MECHERLE, CHRISTOPHER PRATT
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PRATT
Last Name:MECHERLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 BRENNAN LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2752
Mailing Address - Country:US
Mailing Address - Phone:309-838-1831
Mailing Address - Fax:
Practice Address - Street 1:408 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2103
Practice Address - Country:US
Practice Address - Phone:217-937-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer