Provider Demographics
NPI:1669461059
Name:WORTISKA, CHARLES F (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:WORTISKA
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 1:11811 DELL RAPIDS CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5716
Mailing Address - Country:US
Mailing Address - Phone:661-587-8061
Mailing Address - Fax:
Practice Address - Street 1:1405 COMMERCIAL WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0620
Practice Address - Country:US
Practice Address - Phone:661-327-4246
Practice Address - Fax:661-327-4022
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0155770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770449204OtherTAX ID #
CA607200400OtherUS DEPARTMENT OF LABOR
CA770449204OtherTAX ID #
CA607200400OtherUS DEPARTMENT OF LABOR