Healthcare Provider Details

I. General information

NPI: 1730029018
Provider Name (Legal Business Name): CHANTELLA RAYNOR L.A.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 LEINBACH DR STE D3
CHARLESTON SC
29407-7086
US

IV. Provider business mailing address

29 LEINBACH DR STE D3
CHARLESTON SC
29407-7086
US

V. Phone/Fax

Practice location:
  • Phone: 512-300-8937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: