Provider Demographics
NPI:1225574262
Name:SALOMON, CHAD DANIEL (ATS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:DANIEL
Last Name:SALOMON
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 N WALNUT ST
Mailing Address - Street 2:APT A12
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2465
Mailing Address - Country:US
Mailing Address - Phone:812-267-8853
Mailing Address - Fax:
Practice Address - Street 1:2036 N WALNUT ST
Practice Address - Street 2:APT A12
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2465
Practice Address - Country:US
Practice Address - Phone:812-267-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81897390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program