Provider Demographics
NPI:1952048530
Name:JACKSON-CHAPPLE, CAHLIL MICHAEL
Entity Type:Individual
Prefix:
First Name:CAHLIL
Middle Name:MICHAEL
Last Name:JACKSON-CHAPPLE
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 1:11239 FALLS CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2396
Mailing Address - Country:US
Mailing Address - Phone:317-652-7501
Mailing Address - Fax:
Practice Address - Street 1:11239 FALLS CHURCH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2396
Practice Address - Country:US
Practice Address - Phone:317-652-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child