Provider Demographics
NPI:1346306602
Name:CHAPPELL, GREGORY BYRUM (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BYRUM
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:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610-1649
Mailing Address - Country:US
Mailing Address - Phone:231-938-3830
Mailing Address - Fax:231-938-3831
Practice Address - Street 1:3875 M72 EAST
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:MI
Practice Address - Zip Code:49610
Practice Address - Country:US
Practice Address - Phone:231-938-3830
Practice Address - Fax:231-938-3831
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGC007695111N00000X
MI2301007695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M65940Medicare ID - Type Unspecified