Provider Demographics
NPI:1609239987
Name:CHAVEZ- MADRID, JOSE CARLOS (ATC, MAT, LAT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:CHAVEZ- MADRID
Suffix:
Gender:M
Credentials:ATC, MAT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-2532
Mailing Address - Country:US
Mailing Address - Phone:346-770-4180
Mailing Address - Fax:
Practice Address - Street 1:1907 SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-2532
Practice Address - Country:US
Practice Address - Phone:713-894-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program