Provider Demographics
NPI:1295128742
Name:CHAPPELLE, IRENE ELIZABETH (LAC)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:ELIZABETH
Last Name:CHAPPELLE
Suffix:
Gender:F
Credentials:LAC
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 335
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-0335
Mailing Address - Country:US
Mailing Address - Phone:928-242-0949
Mailing Address - Fax:
Practice Address - Street 1:5722 WEBB DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5194
Practice Address - Country:US
Practice Address - Phone:928-242-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist