Provider Demographics
NPI:1003924606
Name:CHAPPELL, BURT ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BURT
Middle Name:ALAN
Last Name:CHAPPELL
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 1:305 NORTH 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 NORTH 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:405-348-5901
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T75368Medicare ID - Type Unspecified
T75368Medicare UPIN