Healthcare Provider Details

I. General information

NPI: 1669308524
Provider Name (Legal Business Name): CHELSEA PHILPOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 OSOLO RD
ELKHART IN
46514-4122
US

IV. Provider business mailing address

405 N HILL ST APT 420
MISHAWAKA IN
46544-1442
US

V. Phone/Fax

Practice location:
  • Phone: 574-262-9619
  • Fax:
Mailing address:
  • Phone: 313-348-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015078A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: