Healthcare Provider Details

I. General information

NPI: 1033595707
Provider Name (Legal Business Name): MARK R CHAPMAN JR. COF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 E INDEPENDENCE BLVD STE M
MATTHEWS NC
28105-5057
US

IV. Provider business mailing address

10931 E INDEPENDENCE BLVD STE M
MATTHEWS NC
28105-5057
US

V. Phone/Fax

Practice location:
  • Phone: 704-844-8234
  • Fax: 704-973-0696
Mailing address:
  • Phone: 704-844-8234
  • Fax: 704-973-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: