Provider Demographics
NPI:1932422029
Name:CHAPMAN, KENNETH GENE
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GENE
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:GENE
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IDC
Mailing Address - Street 1:USS ANZIO
Mailing Address - Street 2:CG-68
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09564-1188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS ANZIO
Practice Address - Street 2:CG-68
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09564-1188
Practice Address - Country:US
Practice Address - Phone:757-444-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman