Provider Demographics
NPI:1598936932
Name:CHARLES J BARTKUS DC PA
Entity Type:Organization
Organization Name:CHARLES J BARTKUS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARTKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-913-1982
Mailing Address - Street 1:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-1633
Mailing Address - Country:US
Mailing Address - Phone:772-913-1982
Mailing Address - Fax:
Practice Address - Street 1:2705 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5068
Practice Address - Country:US
Practice Address - Phone:772-913-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88879OtherBCBS
=========OtherEIN
88879Medicare PIN
=========OtherEIN