Provider Demographics
NPI:1033191689
Name:VIFQUAIN, CHARLES MEYER (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MEYER
Last Name:VIFQUAIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2333
Mailing Address - Country:US
Mailing Address - Phone:816-524-7000
Mailing Address - Fax:816-524-6993
Practice Address - Street 1:319 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2333
Practice Address - Country:US
Practice Address - Phone:816-524-7000
Practice Address - Fax:816-524-6993
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006088111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE155542Medicare PIN