Provider Demographics
NPI:1912125725
Name:CHORPENING, JIMMY L
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:CHORPENING
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 1:1110 8TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-2436
Mailing Address - Country:US
Mailing Address - Phone:515-332-5165
Mailing Address - Fax:
Practice Address - Street 1:611 10TH AVE N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1462
Practice Address - Country:US
Practice Address - Phone:515-332-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0098673Medicaid
IA0213410050Medicare ID - Type UnspecifiedMEDICARE NUMBER