Provider Demographics
NPI:1699829432
Name:CHARLES, DOUGLAS GRANT (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GRANT
Last Name:CHARLES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:600 VESTAVIA PKWY
Mailing Address - Street 2:SUITE 231
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7715
Mailing Address - Country:US
Mailing Address - Phone:205-979-7747
Mailing Address - Fax:205-979-7741
Practice Address - Street 1:600 VESTAVIA PKWY
Practice Address - Street 2:STE. 231
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3756
Practice Address - Country:US
Practice Address - Phone:205-979-7747
Practice Address - Fax:205-979-7741
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01384OtherBLUE CROSS BLUE SHIELD
ALT12615Medicare UPIN