Healthcare Provider Details

I. General information

NPI: 1881397669
Provider Name (Legal Business Name): CHASE CHAPMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6008
US

IV. Provider business mailing address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6008
US

V. Phone/Fax

Practice location:
  • Phone: 573-635-5264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2026031070
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: