Provider Demographics
NPI:1386093557
Name:CHAPPELL PHYSICAL MEDICINE LLC
Entity type:Organization
Organization Name:CHAPPELL PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-348-5901
Mailing Address - Street 1:305 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3681
Mailing Address - Country:US
Mailing Address - Phone:405-348-5901
Mailing Address - Fax:405-348-5923
Practice Address - Street 1:305 N BROADWAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3681
Practice Address - Country:US
Practice Address - Phone:405-348-5901
Practice Address - Fax:405-348-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty