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General NPI Number Information
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NPI Number | 1760693899
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Entity Type | Individual
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Provider Name | MICHAEL A. CHIPMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 405 W JACKSON ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1462
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Country | US
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Telephone | 618-549-0721
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Fax | 618-457-0469
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Provider Business Mailing Address
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Address Line | PO BOX 3988
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City | CARBONDALE
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State | IL
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Zip | 62902-3988
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Country | US
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Telephone | 618-457-5200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 036.133110
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 005202
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 005202
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2246
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036133110
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | R1028
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License Number State | AZ
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Taxonomy #7
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.133110
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License Number State | IL
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