Provider Demographics
NPI:1689832412
Name:CHAPPELL, CRAIG D (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:D
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 W 800 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4097
Mailing Address - Country:US
Mailing Address - Phone:801-610-7321
Mailing Address - Fax:801-610-7306
Practice Address - Street 1:1888 W 800 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062
Practice Address - Country:US
Practice Address - Phone:801-610-7321
Practice Address - Fax:801-610-7306
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9469694-1204207Q00000X, 207QS0010X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1962879940Medicaid