Provider Demographics
NPI:1609895853
Name:GILREATH, CHARLES SIDNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SIDNEY
Last Name:GILREATH
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:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-0650
Mailing Address - Country:US
Mailing Address - Phone:336-835-1517
Mailing Address - Fax:
Practice Address - Street 1:1420 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2335
Practice Address - Country:US
Practice Address - Phone:336-835-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08445OtherBLUE CROSS AND BLUE SHIEL