Healthcare Provider Details

I. General information

NPI: 1144394040
Provider Name (Legal Business Name): KEITH CHIPMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 E COLFAX AVE
DENVER CO
80220-1115
US

IV. Provider business mailing address

4953 SHADOW RIDGE RD
CASTLE ROCK CO
80109-8620
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-1200
  • Fax: 303-320-4830
Mailing address:
  • Phone: 720-733-1357
  • Fax: 303-320-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number125254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: