Provider Demographics
NPI:1295818813
Name:CHARRETTE, DALE JOSEPH (DC, QME)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:JOSEPH
Last Name:CHARRETTE
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LAUREL MANOR DR
Mailing Address - Street 2:STE 204
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5608
Mailing Address - Country:US
Mailing Address - Phone:760-449-4548
Mailing Address - Fax:760-202-8757
Practice Address - Street 1:1950 LAUREL MANOR DR
Practice Address - Street 2:STE 204
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5608
Practice Address - Country:US
Practice Address - Phone:352-259-0024
Practice Address - Fax:352-430-1904
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13587111N00000X
CADC19080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19080Medicare UPIN