Provider Demographics
NPI:1366674533
Name:CHAPMAN, CHARLES C
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 25TH AVE N STE 305
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6528
Mailing Address - Country:US
Mailing Address - Phone:615-329-1268
Mailing Address - Fax:618-329-1232
Practice Address - Street 1:1415 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1618
Practice Address - Country:US
Practice Address - Phone:618-624-4471
Practice Address - Fax:618-624-4496
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN724237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN 724OtherHEARING AID DISPENSER