Healthcare Provider Details

I. General information

NPI: 1215981725
Provider Name (Legal Business Name): DEAN A CHAPEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6635 COMANCHE ST
BONNERS FERRY ID
83805-7523
US

IV. Provider business mailing address

PO BOX 6228
HELENA MT
59604-6228
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-1718
  • Fax: 208-267-7739
Mailing address:
  • Phone: 406-457-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-606
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: