Healthcare Provider Details

I. General information

NPI: 1164029732
Provider Name (Legal Business Name): JERRY CHAPMAN REIKI MASTER III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 VISTA AVE
HOT SPRINGS AR
71901-7019
US

IV. Provider business mailing address

203 VISTA AVE
HOT SPRINGS AR
71901-7019
US

V. Phone/Fax

Practice location:
  • Phone: 501-497-1903
  • Fax:
Mailing address:
  • Phone: 501-497-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number092134946
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: