Provider Demographics
NPI:1710166269
Name:PIKE, CHARLES H III (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:PIKE
Suffix:III
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 1:4075 HIGHWAY 54 STE 200
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-2153
Mailing Address - Country:US
Mailing Address - Phone:573-348-4640
Mailing Address - Fax:573-348-4660
Practice Address - Street 1:4075 HIGHWAY 54 STE 200
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2153
Practice Address - Country:US
Practice Address - Phone:573-348-4640
Practice Address - Fax:573-348-4660
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00433240OtherRAILROAD MEDICARE PIN
MOP00433240OtherRAILROAD MEDICARE PIN