Provider Demographics
NPI:1619085982
Name:GASPER, CHARLANNE (DC)
Entity Type:Individual
Prefix:
First Name:CHARLANNE
Middle Name:
Last Name:GASPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHARLANNE
Other - Middle Name:
Other - Last Name:VENTURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1601 E. LAMAR BLVD
Mailing Address - Street 2:100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2832
Mailing Address - Country:US
Mailing Address - Phone:817-801-5111
Mailing Address - Fax:817-801-5222
Practice Address - Street 1:1601 E. LAMAR BLVD
Practice Address - Street 2:100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2832
Practice Address - Country:US
Practice Address - Phone:817-801-5111
Practice Address - Fax:817-801-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009599111N00000X
CA26507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4D651Medicare ID - Type Unspecified
NYU79636Medicare UPIN