Provider Demographics
NPI:1497747869
Name:PRICE, CHARLES RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:PRICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:934 CANDLELIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3116
Mailing Address - Country:US
Mailing Address - Phone:352-796-2660
Mailing Address - Fax:352-799-4487
Practice Address - Street 1:934 CANDLELIGHT BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3116
Practice Address - Country:US
Practice Address - Phone:352-796-2660
Practice Address - Fax:352-799-4487
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 3752111N00000X
FLCH3752111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4406861OtherUNITED HEALTHCARE
FLCH 0003752OtherWORK COMP
FL88731OtherBCBS
FL001552100Medicaid
FLCH 0003752OtherWORK COMP
FL350003595Medicare PIN
FL001552100Medicaid