Healthcare Provider Details

I. General information

NPI: 1689832412
Provider Name (Legal Business Name): CRAIG D CHAPPELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 W 800 N
PLEASANT GROVE UT
84062
US

IV. Provider business mailing address

1888 W 800 N
PLEASANT GROVE UT
84062-4097
US

V. Phone/Fax

Practice location:
  • Phone: 801-610-7321
  • Fax: 801-610-7306
Mailing address:
  • Phone: 801-610-7321
  • Fax: 801-610-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number9469694-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9469694-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number9469694-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: