Provider Demographics
NPI:1639106271
Name:CHULADA, JOHN CLIFTON (ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLIFTON
Last Name:CHULADA
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 1:20 JONATHAN LN
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3713
Mailing Address - Country:US
Mailing Address - Phone:603-228-2210
Mailing Address - Fax:603-228-2212
Practice Address - Street 1:BOW HIGH SCHOOL
Practice Address - Street 2:32 WHITE ROCK HILL ROAD
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304
Practice Address - Country:US
Practice Address - Phone:603-228-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH001102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer