MEDICARE: DR. GLENN P CHAPMAN II D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2290	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341822320-002	OTHER		MEDICAL MUTUAL OF OHIO
2	000000139788	OTHER		ANTHEM BLUE CROSS BLUE SH
3	341822320-00	OTHER	OH	BWC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154326346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN P CHAPMAN II D.C.

Provider Business Mailing Address
First Line	:	312 W 3RD ST
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1846
Country	:	US
Telephone Number	:	419-734-6250
Fax Number	:	419-734-5612

Provider Business Practice Location Address
First Line	:	312 W 3RD ST
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1846
Country	:	US
Telephone Number	:	419-734-6250
Fax Number	:	419-734-5312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/09/2017

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