Provider Demographics
NPI:1538498522
Name:CHAPMAN, JACOB J (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:J
Last Name:CHAPMAN
Suffix:
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 1:1042 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2418
Mailing Address - Country:US
Mailing Address - Phone:262-284-0500
Mailing Address - Fax:262-284-1019
Practice Address - Street 1:1032 S SPRING ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2455
Practice Address - Country:US
Practice Address - Phone:262-284-0500
Practice Address - Fax:262-284-1019
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4577-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor