Provider Demographics
NPI:1538151121
Name:WHEDON, CHUCK (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:
Last Name:WHEDON
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MULLICA HILL RD
Mailing Address - Street 2:ROWAN UNIVERSITY ATHLETIC TRAINING
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1700
Mailing Address - Country:US
Mailing Address - Phone:856-863-3637
Mailing Address - Fax:856-863-3704
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:ROWAN UNIVERSITY ATHLETIC TRAINING
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1700
Practice Address - Country:US
Practice Address - Phone:856-863-3637
Practice Address - Fax:856-863-3704
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00029700225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MT00029700OtherATHLETIC TRAINER