Provider Demographics
NPI:1376953331
Name:CHADWELL, CRISTIN
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-6251
Mailing Address - Country:US
Mailing Address - Phone:606-682-1360
Mailing Address - Fax:
Practice Address - Street 1:402 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729-6251
Practice Address - Country:US
Practice Address - Phone:606-682-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist