Provider Demographics
NPI:1568516656
Name:BISSELL, CHARLES R (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:BISSELL
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 1:1470 EAST VALLEY ROAD
Mailing Address - Street 2:SUITE M
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108
Mailing Address - Country:US
Mailing Address - Phone:805-565-5252
Mailing Address - Fax:805-565-5250
Practice Address - Street 1:1470 E VALLEY RD
Practice Address - Street 2:SUITE M
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1220
Practice Address - Country:US
Practice Address - Phone:805-565-5252
Practice Address - Fax:805-565-5250
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111NS005XCHIROPRACTI111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
U60096Medicare UPIN
CAWDC23745AMedicare ID - Type Unspecified