Provider Demographics
NPI:1164029732
Name:CHAPMAN, JERRY (REIKI MASTER III)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:REIKI MASTER III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7019
Mailing Address - Country:US
Mailing Address - Phone:501-497-1903
Mailing Address - Fax:
Practice Address - Street 1:203 VISTA AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7019
Practice Address - Country:US
Practice Address - Phone:501-497-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR092134946376K00000X
TN374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty