Provider Demographics
NPI:1568880938
Name:CANTRELL, CHESTEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHESTEN
Middle Name:
Last Name:CANTRELL
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 1:1570 SCUFFLING HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-6430
Mailing Address - Country:US
Mailing Address - Phone:540-243-9137
Mailing Address - Fax:
Practice Address - Street 1:263 FRANKLIN ST STE 5
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1356
Practice Address - Country:US
Practice Address - Phone:540-243-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018952225700000X
VA0104557150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist