Provider Demographics
NPI:1578642781
Name:SEFCIK, CHARLES CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHARLES
Last Name:SEFCIK
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 1:4010 LOCKPORT ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0518
Mailing Address - Country:US
Mailing Address - Phone:701-255-1092
Mailing Address - Fax:
Practice Address - Street 1:1023 E CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1931
Practice Address - Country:US
Practice Address - Phone:701-323-0266
Practice Address - Fax:701-258-0826
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND758111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDV03941Medicare UPIN
ND711631Medicare PIN
ND711632Medicare ID - Type Unspecified