Provider Demographics
NPI:1689255382
Name:CHAPMAN, KELLY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JOHN
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 1:903 EMBARCADERO DR STE 4
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4098
Mailing Address - Country:US
Mailing Address - Phone:916-933-9870
Mailing Address - Fax:
Practice Address - Street 1:6049 DOUGLAS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6249
Practice Address - Country:US
Practice Address - Phone:916-933-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor