Provider Demographics
NPI:1174611024
Name:CHUAPOCO, BRENDAN DOOLEY (LAC)
Entity type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:DOOLEY
Last Name:CHUAPOCO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 39TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3502
Mailing Address - Country:US
Mailing Address - Phone:515-282-4544
Mailing Address - Fax:515-282-4543
Practice Address - Street 1:520 39TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3502
Practice Address - Country:US
Practice Address - Phone:515-282-4544
Practice Address - Fax:515-282-4543
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-22171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist