Provider Demographics
NPI:1497109920
Name:PHARES, CHARLIE (DC)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:PHARES
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 1:2655 S EVERLY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-1506
Mailing Address - Country:US
Mailing Address - Phone:386-846-2045
Mailing Address - Fax:
Practice Address - Street 1:9093 RIDGEFIELD DR STE 107
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6711
Practice Address - Country:US
Practice Address - Phone:301-620-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12009111N00000X
OH4613111N00000X
MD04024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor