Provider Demographics
NPI:1447212600
Name:STROTHER, CHARLES BRYAN (DC FICPA)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRYAN
Last Name:STROTHER
Suffix:
Gender:M
Credentials:DC FICPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117-1734
Mailing Address - Country:US
Mailing Address - Phone:269-469-1310
Mailing Address - Fax:269-469-3969
Practice Address - Street 1:1 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW BUFFALO
Practice Address - State:MI
Practice Address - Zip Code:49117-1734
Practice Address - Country:US
Practice Address - Phone:269-469-1310
Practice Address - Fax:269-469-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS007584111N00000X
IN08002381A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N93640001Medicare ID - Type Unspecified
0N93640001Medicare Oscar/Certification
U75270Medicare UPIN