Provider Demographics
NPI:1548614027
Name:FIELDS, CHASSITY SHANTEL (DC)
Entity Type:Individual
Prefix:
First Name:CHASSITY
Middle Name:SHANTEL
Last Name:FIELDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 US HIGHWAY 27 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-5997
Mailing Address - Country:US
Mailing Address - Phone:859-508-3200
Mailing Address - Fax:859-508-3201
Practice Address - Street 1:1050 US HIGHWAY 27 S
Practice Address - Street 2:SUITE 1
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-5997
Practice Address - Country:US
Practice Address - Phone:859-508-3200
Practice Address - Fax:859-508-3201
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK202810Medicare UPIN