Individual
CHANDLER STARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMT
Contact information
Practice address
4069 LOUISIANA ST, GARY, IN 46409-1841
(773) 988-0438
Mailing address
4069 LOUISIANA ST, GARY, IN 46409-1841
(773) 988-0438
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227021219
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
IN
Enumeration date
08/06/2021
Last updated
08/06/2021
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