Most Relevant Information
Provider Data
| NPI Number: | 1003225863 |
| Provider Name: | JESSE CHAVEZ ATC, LAT |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | 722 |
Most Important Dates
| Enumeration Date: | 08/06/2014 |
| Last Updated: | 08/06/2014 |
Provider Practice Location
2501 N BLACKWELDER AVE
OKLAHOMA CITY
OK
731061402
Practice Location Phone/Fax
| Phone: | 4052086500 |
| Fax: |
Provider Mailing Location
2601 N KENTUCKY AVE APT 413
OKLAHOMA CITY
OK
731061282
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |