Healthcare Provider Details

I. General information

NPI: 1407780190
Provider Name (Legal Business Name): KENNA CHAPIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 JAMES WAY STE 101
PISMO BEACH CA
93449-4974
US

IV. Provider business mailing address

443 REDWOOD WAY
CHICO CA
95926-1751
US

V. Phone/Fax

Practice location:
  • Phone: 805-295-6750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: