Provider Demographics
NPI:1356724827
Name:DANBURY, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DANBURY
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 1:1184 W MAIN ST
Mailing Address - Street 2:GRISWOLD PHYSICAL EDUCATION CENTER
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2039
Mailing Address - Country:US
Mailing Address - Phone:845-988-6028
Mailing Address - Fax:
Practice Address - Street 1:1184 W MAIN ST
Practice Address - Street 2:GRISWOLD PHYSICAL EDUCATION CENTER
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-2039
Practice Address - Country:US
Practice Address - Phone:845-988-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.003536171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor