Provider Demographics
NPI:1457457269
Name:CHASTAIN, CHRISTOPHER ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:CHASTAIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 HUMPHREY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5250
Mailing Address - Country:US
Mailing Address - Phone:423-614-3028
Mailing Address - Fax:
Practice Address - Street 1:9507A OCOEE ST
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8772
Practice Address - Country:US
Practice Address - Phone:423-238-7676
Practice Address - Fax:423-238-7676
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC-001076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3017448OtherBLUE CROSS BLUE SHIELD
TN570222OtherBEECHSTREET
TN3017448OtherBLUE CROSS BLUE SHIELD