Provider Demographics
NPI:1295817179
Name:CHAREST, BRUCE AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:AARON
Last Name:CHAREST
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:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:KIMBERLING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65686-0765
Mailing Address - Country:US
Mailing Address - Phone:417-739-4764
Mailing Address - Fax:417-739-4764
Practice Address - Street 1:21 KIMBERLING BLVD
Practice Address - Street 2:
Practice Address - City:KIMBERLING CITY
Practice Address - State:MO
Practice Address - Zip Code:65686
Practice Address - Country:US
Practice Address - Phone:417-739-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015043019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7525785OtherAETNA PROVIDER NUMBER
FL89381OtherBLUE CROSS BLUE SHIELD
U99475Medicare UPIN
FL89381AMedicare ID - Type Unspecified