Provider Demographics
NPI:1952438996
Name:STAPP, CHAD EDWARD (DPM)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:EDWARD
Last Name:STAPP
Suffix:
Gender:M
Credentials:DPM
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 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-2570
Mailing Address - Fax:605-622-2571
Practice Address - Street 1:310 S PENN ST STE 203
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4553
Practice Address - Country:US
Practice Address - Phone:605-622-2570
Practice Address - Fax:605-622-2571
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD190213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD190OtherDAKOTACARE
SD6802130Medicaid
SDD41481053837OtherPREFERRED ONE
SD253361OtherMIDLANDS CHOICE
ND14717Medicaid
SD4992408OtherWELLMARK BC/BS OF SD
SDD41481053837OtherPREFERRED ONE
ND14717Medicaid