Provider Demographics
NPI:1093832024
Name:ENOUEN, CHARLES W (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:ENOUEN
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 1:15508 W BELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2432
Mailing Address - Country:US
Mailing Address - Phone:623-556-4772
Mailing Address - Fax:
Practice Address - Street 1:15508 W BELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2432
Practice Address - Country:US
Practice Address - Phone:623-556-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ968042Medicare UPIN
AZAZ0241860Medicare UPIN
AZZDC5489Medicare ID - Type UnspecifiedMEDICARE