Provider Demographics
NPI:1770820458
Name:CHARLES, JACQUELIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELIN
Middle Name:
Last Name:CHARLES
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 1:928 GARDEN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1432
Mailing Address - Country:US
Mailing Address - Phone:310-650-8435
Mailing Address - Fax:805-965-6992
Practice Address - Street 1:1114 GARDEN ST APT 4
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1350
Practice Address - Country:US
Practice Address - Phone:310-650-8435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor