Healthcare Provider Details

I. General information

NPI: 1215643754
Provider Name (Legal Business Name): JEFF CHAPMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5736 LEE RD
INDIANAPOLIS IN
46216-2062
US

IV. Provider business mailing address

6610 N SHADELAND AVE
INDIANAPOLIS IN
46220-4392
US

V. Phone/Fax

Practice location:
  • Phone: 317-266-9622
  • Fax:
Mailing address:
  • Phone: 317-266-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: