Healthcare Provider Details

I. General information

NPI: 1366674533
Provider Name (Legal Business Name): CHARLES C CHAPMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W HIGHWAY 50
O FALLON IL
62269-1618
US

IV. Provider business mailing address

310 25TH AVE N STE 305
NASHVILLE TN
37203-6528
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-4471
  • Fax: 618-624-4496
Mailing address:
  • Phone: 615-329-1268
  • Fax: 618-329-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number724
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: