Provider Demographics
NPI:1487640876
Name:CATHRYN CHARETTE DC A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:CATHRYN CHARETTE DC A CHIROPRACTIC CORPORATION
Other - Org Name:CHARETTE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CHARETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-935-1006
Mailing Address - Street 1:587 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6831
Mailing Address - Country:US
Mailing Address - Phone:707-935-1006
Mailing Address - Fax:707-935-7291
Practice Address - Street 1:587 5TH ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6831
Practice Address - Country:US
Practice Address - Phone:707-935-1006
Practice Address - Fax:707-935-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23764111N00000X, 111NR0200X, 111NS0005X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0237640Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAU69211Medicare UPIN
CAZZZ14153ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER