Basic Information
| Provider Information | |||||||||
| NPI: | 1003001181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPPELL | ||||||||
| FirstName: | THEO | ||||||||
| MiddleName: | DICKINSON | ||||||||
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| Credential: | H.H.P., L.M.B.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 FAIRVIEW HILLS DR | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287309777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287131546 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 FAIRVIEW HILLS DR | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287309777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287131546 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 09/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 5556 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.