Provider Demographics
NPI:1720131329
Name:BRUCE M CHAPMAN DPM PA
Entity Type:Organization
Organization Name:BRUCE M CHAPMAN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-790-7840
Mailing Address - Street 1:1911 S 17TH ST
Mailing Address - Street 2:SUITE 130-B
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6662
Mailing Address - Country:US
Mailing Address - Phone:910-790-7840
Mailing Address - Fax:910-790-7828
Practice Address - Street 1:1911 S 17TH ST
Practice Address - Street 2:SUITE 130-B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6662
Practice Address - Country:US
Practice Address - Phone:910-790-7840
Practice Address - Fax:910-790-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC339213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908142Medicaid
NC2346236Medicare ID - Type Unspecified
NC4312890001Medicare NSC
NC7908142Medicaid