Basic Information
| Provider Information | |||||||||
| NPI: | 1093772105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOPKINS | ||||||||
| FirstName: | CHAD | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | MS,ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14301 E ABBIE LN | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624014877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175365091 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1303 W EVERGREEN AVE | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624011619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173423400 | ||||||||
| FaxNumber: | 2173429714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.