Provider Demographics
NPI:1770181943
Name:CHAFFETZ, RACHEL FANTINE (RD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:FANTINE
Last Name:CHAFFETZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WESTFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1594
Mailing Address - Country:US
Mailing Address - Phone:801-808-3928
Mailing Address - Fax:
Practice Address - Street 1:2984 N HILL FIELD RD STE A1-A
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1306
Practice Address - Country:US
Practice Address - Phone:801-888-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered