Provider Demographics
NPI:1215981725
Name:CHAPEL, DEAN A (PA-C)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:CHAPEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6228
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-6228
Mailing Address - Country:US
Mailing Address - Phone:406-457-4180
Mailing Address - Fax:
Practice Address - Street 1:6635 COMANCHE ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-7523
Practice Address - Country:US
Practice Address - Phone:208-267-1718
Practice Address - Fax:208-267-7739
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID043634356OtherBRCHC TAX ID
IDPAF22OtherBLUE CROSS OF IDAHO
ID000010161379OtherREGENCE OF ID
ID000010142695OtherREGENCE OF ID GROUP
ID8H104OtherBLUE CROSS OF ID GROUP
ID8065901Medicaid
ID8065901Medicaid
ID000010161379OtherREGENCE OF ID
ID131822Medicare ID - Type UnspecifiedFQHC BONNERS FERRY
IDQ61323Medicare UPIN
ID1374276Medicare ID - Type UnspecifiedPART B GROUP