Provider Demographics
NPI:1093469561
Name:FLECK, CHARLES EDWARD (DSOM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:FLECK
Suffix:
Gender:M
Credentials:DSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39420 SE GORDON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CORBETT
Mailing Address - State:OR
Mailing Address - Zip Code:97019-8750
Mailing Address - Country:US
Mailing Address - Phone:503-695-2977
Mailing Address - Fax:
Practice Address - Street 1:39420 SE GORDON CREEK RD
Practice Address - Street 2:
Practice Address - City:CORBETT
Practice Address - State:OR
Practice Address - Zip Code:97019-8750
Practice Address - Country:US
Practice Address - Phone:503-695-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC208298171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist