Provider Demographics
NPI:1568469005
Name:CHARTOFF, MICHAEL ETHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ETHAN
Last Name:CHARTOFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:162 BOYLSTON ST
Mailing Address - Street 2:SUITE 41
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4613
Mailing Address - Country:US
Mailing Address - Phone:617-451-1111
Mailing Address - Fax:617-451-1122
Practice Address - Street 1:162 BOYLSTON ST
Practice Address - Street 2:SUITE 41
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4613
Practice Address - Country:US
Practice Address - Phone:617-451-1111
Practice Address - Fax:617-451-1122
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2691716OtherAETNA
MA794755OtherTUFTS
MA21224282786-01OtherBEECH ST
MAP3197246OtherOXFORD
MA26133OtherFALLEN
MA350446OtherHARVARD PILGRIM
MAY36585OtherBCBS
MA350446OtherHARVARD PILGRIM