Provider Demographics
NPI:1083087332
Name:CHAPMAN MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:CHAPMAN MEDICAL CLINIC LLC
Other - Org Name:CHAPMAN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:DENAE
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP, APRN
Authorized Official - Phone:417-209-2773
Mailing Address - Street 1:101 N ELM ST STE E
Mailing Address - Street 2:
Mailing Address - City:PIERCE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65723-1233
Mailing Address - Country:US
Mailing Address - Phone:417-576-7389
Mailing Address - Fax:
Practice Address - Street 1:101 N ELM ST STE E
Practice Address - Street 2:
Practice Address - City:PIERCE CITY
Practice Address - State:MO
Practice Address - Zip Code:65723-1233
Practice Address - Country:US
Practice Address - Phone:417-476-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1530832888261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center