Provider Demographics
NPI:1720419906
Name:PROCTOR, DEAN CHANEY (ATC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:CHANEY
Last Name:PROCTOR
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 1:1630 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-8915
Mailing Address - Country:US
Mailing Address - Phone:704-680-7949
Mailing Address - Fax:
Practice Address - Street 1:1630 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-8915
Practice Address - Country:US
Practice Address - Phone:704-680-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2255A2300XOtherRESPITORY THERAPY