| Organization Name: | CHAMPION FITNESS, INC |
| NPI Number: | 1114313467 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL COHLMAN (CEO) |
| Mailing Address: | 902 E Oak St Ste 3 Fairbury |
| State: | IL US |
| Postal Code: | 617391301 |
| Phone Number: | 8156926200 |
| Fax Number: | 8156926202 |
| NPI Enumeration Date: | 04/14/2015 |
| NPI Last Update Date: | 05/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |