Provider Demographics
NPI:1154326346
Name:CHAPMAN, GLENN P II (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:P
Last Name:CHAPMAN
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1846
Mailing Address - Country:US
Mailing Address - Phone:419-734-6250
Mailing Address - Fax:419-734-5612
Practice Address - Street 1:312 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1846
Practice Address - Country:US
Practice Address - Phone:419-734-6250
Practice Address - Fax:419-734-5312
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
341822320-002OtherMEDICAL MUTUAL OF OHIO
000000139788OtherANTHEM BLUE CROSS BLUE SH
OH341822320-00OtherBWC
OH0240313Medicaid
OH341822320-00OtherBWC
341822320-002OtherMEDICAL MUTUAL OF OHIO