Provider Demographics
NPI:1457324212
Name:BACH, CHARLENE ANNETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:ANNETTE
Last Name:BACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHARLENE
Other - Middle Name:ANNETTE
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7801 BEECHMONT AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-4211
Mailing Address - Country:US
Mailing Address - Phone:513-231-4100
Mailing Address - Fax:513-231-4971
Practice Address - Street 1:7801 BEECHMONT AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4211
Practice Address - Country:US
Practice Address - Phone:513-231-4100
Practice Address - Fax:513-231-4971
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240304Medicaid
OHU62108Medicare UPIN
OHBA0805832Medicare ID - Type Unspecified