Provider Demographics
NPI:1053532176
Name:CHAMBERS, JEFFREY LEE (ATC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEE
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-3040
Mailing Address - Country:US
Mailing Address - Phone:507-387-7685
Mailing Address - Fax:507-389-5352
Practice Address - Street 1:135 MYERS FIELDHOUSE
Practice Address - Street 2:MINNESOTA STATE UNIVERSITY
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6171
Practice Address - Country:US
Practice Address - Phone:507-389-3229
Practice Address - Fax:507-389-5352
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer