Provider Demographics
NPI:1942434584
Name:CHADWICK, CHRISTIE L (LMBT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:L
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 POOLE RD STE E
Mailing Address - Street 2:
Mailing Address - City:BELVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1248
Mailing Address - Country:US
Mailing Address - Phone:910-712-2712
Mailing Address - Fax:
Practice Address - Street 1:143 POOLE RD STE E
Practice Address - Street 2:
Practice Address - City:BELVILLE
Practice Address - State:NC
Practice Address - Zip Code:28451-1248
Practice Address - Country:US
Practice Address - Phone:910-712-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011896225700000X
NC13048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist