Provider Demographics
NPI:1558481903
Name:RASSEL, CHARLES P (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:RASSEL
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 1:330 W FELICITA AVE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6530
Mailing Address - Country:US
Mailing Address - Phone:760-489-0303
Mailing Address - Fax:760-489-0480
Practice Address - Street 1:330 W FELICITA AVE
Practice Address - Street 2:SUITE B-1
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6530
Practice Address - Country:US
Practice Address - Phone:760-489-0303
Practice Address - Fax:760-489-0480
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC11798AMedicare PIN