Dane R Secor, ATC – Athletic Trainer in Culver, IN

Key facts

NPI: 1235899170
Entity type: Individual (NPI type 1)
Primary specialty: Athletic Trainer 2255A2300X
License: 36003521A (IN)
Practice address: 1300 Academy Rd # 10
Culver, IN 46511-1234
Phone: (574) 842-7000
NPI assigned: Dec 20, 2021
Sex: Male
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
36003521A	IN	MD	Athletic Trainer

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Athletic Trainer	2255A2300X	36003521A	IN	Yes

Addresses

Primary practice location

1300 Academy Rd # 10
Culver, IN 46511-1234

Mailing address

1300 Academy Rd # 10
Culver, IN 46511-1234

Electronic endpoints

Type	Endpoint	Use	Affiliation
Direct Messaging Address	dane.secor@culver.org	Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 20, 2021.

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1235899170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 ACADEMY RD # 10",
            "city": "CULVER",
            "state": "IN",
            "postal_code": "465111234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ACADEMY RD # 10",
            "city": "CULVER",
            "state": "IN",
            "postal_code": "465111234",
            "telephone_number": "574-842-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SECOR",
        "first_name": "DANE",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-20",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36003521A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dane.secor@culver.org",
            "affiliation": "N",
            "endpointDescription": "work secure email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1300 Academy Rd # 10",
            "city": "Culver",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465111234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Culver, IN

All providers in Culver, IN · Athletic Trainer in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.