Provider Demographics
NPI:1043388283
Name:SHIVER, CHARLES ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:SHIVER
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:PO BOX 311427
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1427
Mailing Address - Country:US
Mailing Address - Phone:334-393-9355
Mailing Address - Fax:334-393-4372
Practice Address - Street 1:809 E LEE ST STE A
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2072
Practice Address - Country:US
Practice Address - Phone:334-393-9355
Practice Address - Fax:334-393-4372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-54001OtherBLUE CROSS BLUE SHIELD
AL051554001Medicare PIN
AL515-54001OtherBLUE CROSS BLUE SHIELD