Provider Demographics
NPI:1619022720
Name:GAGARIN, CHARLES PHILLIP (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PHILLIP
Last Name:GAGARIN
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 1:13766 CENTER ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9693
Mailing Address - Country:US
Mailing Address - Phone:831-659-8009
Mailing Address - Fax:831-659-8009
Practice Address - Street 1:13766 CENTER ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CARMEL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93924-9693
Practice Address - Country:US
Practice Address - Phone:831-659-8009
Practice Address - Fax:831-659-8009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 13520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor