Provider Demographics
NPI:1467592758
Name:CHIAPPETTA SHOES INC
Entity Type:Organization
Organization Name:CHIAPPETTA SHOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIAPPETTA
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:262-657-9142
Mailing Address - Street 1:6821 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7127
Mailing Address - Country:US
Mailing Address - Phone:262-657-9142
Mailing Address - Fax:262-657-9169
Practice Address - Street 1:6821 39TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7127
Practice Address - Country:US
Practice Address - Phone:262-657-9142
Practice Address - Fax:262-657-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI875335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0761420001Medicare NSC