Provider Demographics
NPI:1568507341
Name:HAFELE, CHARLES BORG (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BORG
Last Name:HAFELE
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 1:6527 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1029
Mailing Address - Country:US
Mailing Address - Phone:513-931-7325
Mailing Address - Fax:513-672-0781
Practice Address - Street 1:6527 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:513-931-7325
Practice Address - Fax:513-931-7324
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOHIO1564111N00000X
FL0006186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135053Medicaid
OH31131546700OtherWORK & DUP
15597OtherANTHEM
OH398360001OtherCARE SOURCE
OH398360001OtherCARE SOURCE
U17112Medicare UPIN