Individual provider Active NPI

Chantelle Renee Paul, D.C.

  • Chiropractor
  • Willis, TX
National Provider Identifier
1871926006
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
12346 Issued in TX
Practice address
9611 FM 1097 Rd W Ste 300
Willis, TX 77318-5834
Phone
(936) 230-5515
NPI assigned
Aug 12, 2013
Last updated
Mar 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 12346 TX Primary

Addresses

Primary practice location

9611 FM 1097 Rd W Ste 300
Willis, TX 77318-5834

Mailing address

21899 Valley Ranch Crossing Dr
Porter, TX 77365-5496
Phone (231) 420-2165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140819002539 TX Practitioner - Chiropractic 7810115607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9611 FM 1097 Rd W
Suite 300
Willis, TX 77318-5834
Phone (936) 230-5515

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12346TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Sandstone Chiropractic Conroe, PLLC Chiropractor CurrentSince Dec 11, 2016 Accepting new patients
Sandstone Chiropratic, P.a. Chiropractor CurrentSince Mar 10, 2016 Accepting new patients

Locations

125 Blue Heron Dr
#B
Montgomery, TX 77316
Phone (936) 253-5314

9611 FM 1097 Rd W
Ste 300
Willis, TX 77318
Phone (936) 230-5515

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1871926006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21899 VALLEY RANCH CROSSING DR",
            "city": "PORTER",
            "state": "TX",
            "postal_code": "773655496",
            "telephone_number": "231-420-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9611 FM 1097 RD W STE 300",
            "city": "WILLIS",
            "state": "TX",
            "postal_code": "773185834",
            "telephone_number": "936-230-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUL",
        "first_name": "CHANTELLE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "12346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willis, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.