Provider Demographics
NPI:1316545916
Name:STORM, CHANIN D (LMT)
Entity Type:Individual
Prefix:MS
First Name:CHANIN
Middle Name:D
Last Name:STORM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 WOODRUFF WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-2514
Mailing Address - Country:US
Mailing Address - Phone:240-586-9237
Mailing Address - Fax:
Practice Address - Street 1:1719 WOODRUFF WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-2514
Practice Address - Country:US
Practice Address - Phone:240-586-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist