Ethan Thomas Chavez, ATC

Key facts

NPI

1336780584

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

328474 (LA)

Practice address

7250 State Ave
Kansas City, KS 66112-3003

Phone

(913) 288-7511

NPI assigned

Sep 30, 2019

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

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 4, 2023.

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1336780584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 N FRANKFORD AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794169643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 STATE AVE",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661123003",
            "telephone_number": "913-288-7511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2407 N Frankford Ave",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794169643",
            "country_code": "US",
            "telephone_number": "806-283-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "ETHAN",
        "middle_name": "THOMAS",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-30",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "LA",
            "license": "328474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, KS

• Alexander P Charlton
• Karen Chastain, RN
• Kevin Scott Chatley, MD
• Kacy Lee Chau, MD
• Suchana Chaulagain, MD
• Thomas Faustino Chavez
• Vincent Chavez
• Raymond Che
• Mona Chebaro, MA. ATR
• Linah Chelagat

All providers in Kansas City, KS · Athletic Trainer in Kansas