Provider Demographics
NPI:1922066547
Name:CANTRELL, CHRISTINA R (DC,BS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:R
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:DC,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1352
Mailing Address - Street 2:310 S. LINCOLN AVE
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-1352
Mailing Address - Country:US
Mailing Address - Phone:816-718-0857
Mailing Address - Fax:816-318-8425
Practice Address - Street 1:310 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9762
Practice Address - Country:US
Practice Address - Phone:816-718-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031368111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO697680OtherACN
MO11516513OtherCAQH
MO36497025OtherBCBS
MO744328OtherHEALTHLINK
MO697680OtherACN
MO36497025OtherBCBS