Provider Demographics
NPI:1740427814
Name:STAFFORD, CHARLES ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:STAFFORD
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 1:2430 FM 407
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3091
Mailing Address - Country:US
Mailing Address - Phone:214-608-3283
Mailing Address - Fax:214-237-4418
Practice Address - Street 1:2430 FM 407
Practice Address - Street 2:SUITE B
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3091
Practice Address - Country:US
Practice Address - Phone:214-608-3283
Practice Address - Fax:214-237-4418
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor