Provider Demographics
NPI:1023823903
Name:CHAPPELL, JOHN EDWARD
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 DANA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1137
Mailing Address - Country:US
Mailing Address - Phone:614-207-0064
Mailing Address - Fax:
Practice Address - Street 1:2211 LAKE CLUB DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3204
Practice Address - Country:US
Practice Address - Phone:614-488-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty