Provider Demographics
NPI:1659332187
Name:CHAGNON, MICHAEL ADRIAN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ADRIAN
Last Name:CHAGNON
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 1:23 COBB AVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-3622
Mailing Address - Country:US
Mailing Address - Phone:508-451-5437
Mailing Address - Fax:
Practice Address - Street 1:23 COBB AVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-3622
Practice Address - Country:US
Practice Address - Phone:508-451-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer