MEDICARE: SHILOUH CHANDLER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	227.023873	IL
2	225700000X	Massage Therapist	2024050343	MO

General Provider Information

NPI Number	:	1235000555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHILOUH CHANDLER LMT

Provider Business Mailing Address
First Line	:	10303 WINE HILL RD
Second Line	:
City	:	CHESTER
State	:	IL
Zip	:	62233-3307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11777 GRAVOIS RD STE B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1822
Country	:	US
Telephone Number	:	314-252-0153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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Directions to “ SHILOUH CHANDLER LMT” Practice Location

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