Basic Information
Provider Information
NPI: 1003001181
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAPPELL
FirstName: THEO
MiddleName: DICKINSON
NamePrefix:  
NameSuffix:  
Credential: H.H.P., L.M.B.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000X5556NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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