Healthcare Provider Details

I. General information

NPI: 1649392887
Provider Name (Legal Business Name): NATHAN L CHAPMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 14TH ST
MURPHYSBORO IL
62966-2982
US

IV. Provider business mailing address

305 E RANDOLPH ST
PINCKNEYVILLE IL
62274-1421
US

V. Phone/Fax

Practice location:
  • Phone: 618-684-2136
  • Fax:
Mailing address:
  • Phone: 618-357-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: