Provider Demographics
NPI:1689443624
Name:CHILDERS, COLE CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:CHRISTOPHER
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S 1230 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5865
Mailing Address - Country:US
Mailing Address - Phone:360-768-6495
Mailing Address - Fax:
Practice Address - Street 1:430 S 1230 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5865
Practice Address - Country:US
Practice Address - Phone:360-768-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program