Provider Demographics
NPI:1952922353
Name:CHENNELL, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:CHENNELL
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 1:5720 FRISCO SQUARE BLVD APT 1057
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3330
Mailing Address - Country:US
Mailing Address - Phone:513-519-9394
Mailing Address - Fax:
Practice Address - Street 1:1 COWBOYS WAY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1963
Practice Address - Country:US
Practice Address - Phone:513-519-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000038305OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER