Provider Demographics
NPI:1275957995
Name:GLENN P CHAPMAN II DC LLC
Entity Type:Organization
Organization Name:GLENN P CHAPMAN II DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:419-734-6250
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:419-734-5312
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty