Provider Demographics
NPI:1154657690
Name:HARPER, CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:HARPER
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 1:3201 PACIFIC COAST HWY
Mailing Address - Street 2:A
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2200
Mailing Address - Country:US
Mailing Address - Phone:310-376-8949
Mailing Address - Fax:310-798-2569
Practice Address - Street 1:3201 PACIFIC COAST HWY
Practice Address - Street 2:A
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2200
Practice Address - Country:US
Practice Address - Phone:310-376-8949
Practice Address - Fax:310-798-2569
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor