Provider Demographics
NPI:1568591279
Name:MCCUNE, CHAD ERIC (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ERIC
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 MARS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6575
Mailing Address - Country:US
Mailing Address - Phone:254-761-5650
Mailing Address - Fax:254-761-5772
Practice Address - Street 1:8200 MARS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6575
Practice Address - Country:US
Practice Address - Phone:254-761-5650
Practice Address - Fax:254-761-5772
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT22452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer