Provider Demographics
NPI:1265651939
Name:HUSTON, CHARISSE J (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARISSE
Middle Name:J
Last Name:HUSTON
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 1:270 E HIGHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6605
Mailing Address - Country:US
Mailing Address - Phone:142-209-4414
Mailing Address - Fax:
Practice Address - Street 1:270 E HIGHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6605
Practice Address - Country:US
Practice Address - Phone:142-209-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006414111N00000X
WI2644111N00000X
PADC-006569-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHU047162Medicare ID - Type Unspecified
PAU28098Medicare UPIN