MEDICARE: THEO DICKINSON CHAPPELL H.H.P., L.M.B.T.

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	5556	NC

General Provider Information

NPI Number	:	1003001181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEO DICKINSON CHAPPELL H.H.P., L.M.B.T.

Provider Business Mailing Address
First Line	:	2 FAIRVIEW HILLS DR
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9777
Country	:	US
Telephone Number	:	828-713-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 FAIRVIEW HILLS DR
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9777
Country	:	US
Telephone Number	:	828-713-1546
Fax Number	:

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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