Provider Demographics
NPI:1104618677
Name:VAN DOORN, CHANTALLE
Entity type:Individual
Prefix:
First Name:CHANTALLE
Middle Name:
Last Name:VAN DOORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SW 160TH AVE APT 435
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5017
Mailing Address - Country:US
Mailing Address - Phone:310-491-6075
Mailing Address - Fax:
Practice Address - Street 1:1050 SW 160TH AVE APT 435
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5017
Practice Address - Country:US
Practice Address - Phone:310-491-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach