Provider Demographics
NPI:1184172058
Name:CHABON, NICHOLAS JOEL (LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOEL
Last Name:CHABON
Suffix:
Gender:M
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:300 13TH ST W
Mailing Address - Street 2:ARMORY GYMNASIUM
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5145
Mailing Address - Country:US
Mailing Address - Phone:406-265-3761
Mailing Address - Fax:406-265-4129
Practice Address - Street 1:300 13TH ST W
Practice Address - Street 2:ARMORY GYMNASIUM
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5145
Practice Address - Country:US
Practice Address - Phone:406-265-3761
Practice Address - Fax:406-265-4129
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MTATR-LAT-LIC-13522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer