Provider Demographics
NPI:1114313442
Name:CHAMPION FITNESS, INC
Entity Type:Organization
Organization Name:CHAMPION FITNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-844-5411
Mailing Address - Street 1:924 W CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1067
Mailing Address - Country:US
Mailing Address - Phone:815-844-5411
Mailing Address - Fax:815-844-5322
Practice Address - Street 1:548 E SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:IL
Practice Address - Zip Code:61910-1801
Practice Address - Country:US
Practice Address - Phone:217-268-3188
Practice Address - Fax:217-268-4360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAMPION FITNESS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy