Provider Demographics
NPI:1508379108
Name:CHAPMAN, DUSTIN WILLIS
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:WILLIS
Last Name:CHAPMAN
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 1:7604 W 95TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-6131
Mailing Address - Country:US
Mailing Address - Phone:913-908-1984
Mailing Address - Fax:
Practice Address - Street 1:15319 W 95TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1262
Practice Address - Country:US
Practice Address - Phone:913-495-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03270225200000X
MO2017033102225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant