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General NPI Number Information
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NPI Number | 1184988834
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Entity Type | Organization
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Legal Business Name | CHARLESTON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 204 N 1ST ST
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City | CHARLESTON
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State | MO
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Zip | 63834-1100
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Country | US
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Telephone | 573-683-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N 1ST ST
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City | CHARLESTON
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State | MO
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Zip | 63834-1100
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Country | US
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Telephone | 573-683-3080
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. REBECCA CHAPMAN
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Credential | D.C.
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Telephone | 573-683-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2011037377
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License Number State | MO
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