Provider Demographics
NPI:1992728505
Name:CHAPMAN, PHILLIP S (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:S
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2339
Mailing Address - Country:US
Mailing Address - Phone:816-781-8810
Mailing Address - Fax:816-781-3468
Practice Address - Street 1:257 W MILL ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2339
Practice Address - Country:US
Practice Address - Phone:816-781-8810
Practice Address - Fax:816-781-3468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV04300Medicare UPIN
T20D737Medicare ID - Type Unspecified