Provider Demographics
NPI:1689634495
Name:POOL, CHARLES BRYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRYAN
Last Name:POOL
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 1:1400 E DENMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901
Mailing Address - Country:US
Mailing Address - Phone:936-632-6868
Mailing Address - Fax:936-632-8436
Practice Address - Street 1:1400 E DENMAN AVENUE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901
Practice Address - Country:US
Practice Address - Phone:936-632-6868
Practice Address - Fax:936-632-8436
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8248292OtherBLUE LINK
TX001744401Medicaid
U48292Medicare UPIN
TX001744401Medicaid