Provider Demographics
NPI:1841419256
Name:KRAWIEC, CHAD J (ATC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:KRAWIEC
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 1:13791 FIRELIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5047
Mailing Address - Country:US
Mailing Address - Phone:617-905-7329
Mailing Address - Fax:
Practice Address - Street 1:2645 VIKINGS CIR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1963
Practice Address - Country:US
Practice Address - Phone:952-456-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9822255A2300X
MN28162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer