Provider Demographics
NPI:1518587211
Name:CHALLANDES, ELLIOTT (LMT)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:CHALLANDES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 S 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2274
Mailing Address - Country:US
Mailing Address - Phone:217-416-7649
Mailing Address - Fax:
Practice Address - Street 1:838 S 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2274
Practice Address - Country:US
Practice Address - Phone:217-416-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.019555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist