Provider Demographics
NPI:1144404013
Name:DR. JAMES CHAPKO D.D.S., P.C.
Entity Type:Organization
Organization Name:DR. JAMES CHAPKO D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:CHAPKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-544-5144
Mailing Address - Street 1:140 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3518
Mailing Address - Country:US
Mailing Address - Phone:815-544-5144
Mailing Address - Fax:815-544-5161
Practice Address - Street 1:140 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3518
Practice Address - Country:US
Practice Address - Phone:815-544-5144
Practice Address - Fax:815-544-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019738302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization