Provider Demographics
NPI:1952343063
Name:CHAPMAN, BRUCE MANNING (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:MANNING
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC339213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908142Medicaid
NCU34002Medicare UPIN
NC7908142Medicaid