Provider Demographics
NPI:1548345960
Name:CHIPOURAS, CHRISTIAN MARK (DPT,MS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MARK
Last Name:CHIPOURAS
Suffix:
Gender:M
Credentials:DPT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2012 PHALAROPE CT
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4734
Mailing Address - Country:US
Mailing Address - Phone:323-806-9096
Mailing Address - Fax:714-241-1007
Practice Address - Street 1:2012 PHALAROPE CT
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4734
Practice Address - Country:US
Practice Address - Phone:323-806-9096
Practice Address - Fax:714-241-1007
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT29077Medicare ID - Type UnspecifiedPHYSICAL THERAPY