Provider Demographics
NPI:1407254451
Name:CHESTERFIELD, MICHAEL JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:CHESTERFIELD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-1240
Mailing Address - Country:US
Mailing Address - Phone:814-393-2006
Mailing Address - Fax:814-393-1735
Practice Address - Street 1:840 WOOD ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1240
Practice Address - Country:US
Practice Address - Phone:814-393-2006
Practice Address - Fax:814-393-1735
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0043832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART004383OtherCOMMONWEALTH OF PA DEPT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIR