Provider Demographics
NPI:1285664672
Name:LINDQUIST, CHARLES WILLIAM (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1929
Mailing Address - Country:US
Mailing Address - Phone:937-548-7663
Mailing Address - Fax:937-547-9175
Practice Address - Street 1:607 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1929
Practice Address - Country:US
Practice Address - Phone:937-548-7663
Practice Address - Fax:937-547-9175
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH970111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341389381-00OtherBUREAU OF WORKERS COMP
OH0511708Medicaid
OHT47776Medicare UPIN
OHLI0527131Medicare ID - Type Unspecified