Provider Demographics
NPI:1225086812
Name:CHARLES, RAYMOND IGOR (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:IGOR
Last Name:CHARLES
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 1:10620 N 71ST PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6703
Mailing Address - Country:US
Mailing Address - Phone:480-948-5217
Mailing Address - Fax:480-948-1749
Practice Address - Street 1:10620 N 71ST PL
Practice Address - Street 2:SUITE C
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6703
Practice Address - Country:US
Practice Address - Phone:480-948-5217
Practice Address - Fax:480-948-1749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC 4292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0241280OtherBLUE CROSS BLUE SHIELD
AZDC42922Medicare ID - Type Unspecified