Provider Demographics
NPI:1689672099
Name:CHARETTE, ARTHUR LEON (DC QME)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:LEON
Last Name:CHARETTE
Suffix:
Gender:M
Credentials:DC QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6831
Mailing Address - Country:US
Mailing Address - Phone:707-935-1006
Mailing Address - Fax:707-935-7291
Practice Address - Street 1:587 5TH ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6831
Practice Address - Country:US
Practice Address - Phone:707-935-1006
Practice Address - Fax:707-935-7291
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23764111N00000X, 111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0237640Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAZZZ14153ZMedicare ID - Type UnspecifiedCORPORATE/GROUP NUMBER
CAU69211Medicare UPIN