=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881056877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATIONAL CHAPLAIN PRACTITIONERS ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2016
-----------------------------------------------------
Last Update Date | 03/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 364 E MAIN ST SUITE 194
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19709-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-526-6548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 364 E MAIN ST SUITE 194
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19709-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-526-6548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JARED OMAR JACKSON
-----------------------------------------------------
Credential | D.MIN
-----------------------------------------------------
Telephone | 302-526-6548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------