Provider Demographics
NPI:1154992394
Name:CHAMBERLAIN, RACHELLE ELISE (DC)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ELISE
Last Name:CHAMBERLAIN
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 1:619 N MORTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-4098
Mailing Address - Country:US
Mailing Address - Phone:812-822-2592
Mailing Address - Fax:
Practice Address - Street 1:619 N MORTON ST STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-4098
Practice Address - Country:US
Practice Address - Phone:812-822-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003244A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor