Provider Demographics
NPI:1396880241
Name:CHARLES W CHAPPLE DC SC
Entity type:Organization
Organization Name:CHARLES W CHAPPLE DC SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-894-8778
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:60172-2007
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:60172-2007
Practice Address - Country:US
Practice Address - Phone:630-894-8778
Practice Address - Fax:630-894-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042616694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0618371001OtherCIGNA
IL02221909OtherBLUE CROSS BLUE SHIELD
269750Medicare PIN
IL02221909OtherBLUE CROSS BLUE SHIELD