Provider Demographics
NPI:1417070079
Name:SPILLIAERT, CHANTAL JEANNINE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:CHANTAL
Middle Name:JEANNINE
Last Name:SPILLIAERT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 MCCLURE RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2003
Mailing Address - Country:US
Mailing Address - Phone:505-527-2673
Mailing Address - Fax:
Practice Address - Street 1:345 MCCLURE RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2003
Practice Address - Country:US
Practice Address - Phone:505-527-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2125225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist