Provider Demographics
NPI:1164547576
Name:VARTANIAN, CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:VARTANIAN
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 1:65 NORTHGATE PLZ
Mailing Address - Street 2:SUITE #10
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-5900
Mailing Address - Country:US
Mailing Address - Phone:802-888-5222
Mailing Address - Fax:802-888-5223
Practice Address - Street 1:65 NORTHGATE PLZ
Practice Address - Street 2:SUITE #10
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-5900
Practice Address - Country:US
Practice Address - Phone:802-888-5222
Practice Address - Fax:802-888-5223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060000747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009615Medicaid
VT8725OtherVT BLUE CROSS BLUE SHIELD
VTVT9615Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER