Provider Demographics
NPI:1972747459
Name:PROCTOR, CHRISTOPHER TRIPP (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TRIPP
Last Name:PROCTOR
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 1:303 S COMMERCIAL ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2125
Mailing Address - Country:US
Mailing Address - Phone:618-252-5555
Mailing Address - Fax:618-252-2279
Practice Address - Street 1:303 S COMMERCIAL ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2125
Practice Address - Country:US
Practice Address - Phone:618-252-5555
Practice Address - Fax:618-252-2279
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer