Provider Demographics
NPI:1588177273
Name:STARKE, CHEYENNE AUTUMN
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:AUTUMN
Last Name:STARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:AUTUMN
Other - Last Name:CARLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 W FRANCIS AVE # 163
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 W FRANCIS AVE
Practice Address - Street 2:# 163
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6834
Practice Address - Country:US
Practice Address - Phone:509-818-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist