Provider Demographics
NPI:1497844948
Name:STAPEL, RALPH GORDON JR (CH)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:GORDON
Last Name:STAPEL
Suffix:JR
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 E 400 S # D
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1900
Mailing Address - Country:US
Mailing Address - Phone:801-491-8688
Mailing Address - Fax:801-491-8828
Practice Address - Street 1:269 E 400 S # D
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1900
Practice Address - Country:US
Practice Address - Phone:801-491-8688
Practice Address - Fax:801-491-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5685491-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU62176Medicare UPIN
UT000056369Medicare ID - Type Unspecified
IN070860KKKMedicare PIN
IN069860GGGMedicare PIN