Provider Demographics
NPI:1518015254
Name:VETTES, CHARLES F (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:VETTES
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 1:8732 WESTMINSTER BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4656
Mailing Address - Country:US
Mailing Address - Phone:714-895-0070
Mailing Address - Fax:
Practice Address - Street 1:8732 WESTMINSTER BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4656
Practice Address - Country:US
Practice Address - Phone:714-895-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24021OtherCAL. PIPE TRADES TRUST
CADC0240210OtherBLUE CROSS BLUE SHIELD
CADC24021Medicare PIN