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General NPI Number Information
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NPI Number | 1467592758
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Entity Type | Organization
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Legal Business Name | CHIAPPETTA SHOES INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 6821 39TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-7127
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Country | US
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Telephone | 262-657-9142
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Fax | 262-657-9169
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Provider Business Mailing Address
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Address Line | 6821 39TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-7127
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Country | US
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Telephone | 262-657-9142
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Fax | 262-657-9169
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRED C CHIAPPETTA
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Credential | CERTIFIED PEDORTHIST
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Telephone | 262-657-9142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 875
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License Number State | WI
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