Provider Demographics
NPI:1114160330
Name:FLEMING, CHARLOTTE WINNETTE (DC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:WINNETTE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W. ABRIENDO AVE.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1870
Mailing Address - Country:US
Mailing Address - Phone:719-544-1468
Mailing Address - Fax:719-543-2357
Practice Address - Street 1:255 W. ABRIENDO AVE.
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1870
Practice Address - Country:US
Practice Address - Phone:719-544-1468
Practice Address - Fax:719-543-2357
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor