Provider Demographics
NPI:1164888392
Name:JONES, CHAD (ATC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4012 CIBOLA VILLAGE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4180
Mailing Address - Country:US
Mailing Address - Phone:240-994-3610
Mailing Address - Fax:
Practice Address - Street 1:800 ODELIA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1619
Practice Address - Country:US
Practice Address - Phone:505-843-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
060002331OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
NM614OtherSTATE OF NEW MEXICO REGULATION & LICENSING DEPARTMENT