Provider Demographics
NPI:1740223270
Name:MAYABB, CHARLES EMMETT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EMMETT
Last Name:MAYABB
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 1:130 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1020
Mailing Address - Country:US
Mailing Address - Phone:859-292-0037
Mailing Address - Fax:859-292-0047
Practice Address - Street 1:453 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-9598
Practice Address - Country:US
Practice Address - Phone:937-444-1166
Practice Address - Fax:937-444-1166
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor