Provider Demographics
NPI:1679696736
Name:CHAPPLE, CHARLES W (DC FICPA)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:CHAPPLE
Suffix:
Gender:M
Credentials:DC FICPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172
Mailing Address - Country:US
Mailing Address - Phone:630-894-8778
Mailing Address - Fax:630-894-8873
Practice Address - Street 1:360 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172
Practice Address - Country:US
Practice Address - Phone:630-894-8778
Practice Address - Fax:630-894-8873
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0618371001OtherCIGNA
IL02221909OtherBCBS
IL02221909OtherBCBS
IL0618371001OtherCIGNA