Provider Demographics
NPI:1811007206
Name:CHARLTON, CHANCE JEFFREY (DC)
Entity Type:Individual
Prefix:
First Name:CHANCE
Middle Name:JEFFREY
Last Name:CHARLTON
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 1:222 MAIN STREET BOX 1227
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-1227
Mailing Address - Country:US
Mailing Address - Phone:907-842-2300
Mailing Address - Fax:907-842-2303
Practice Address - Street 1:222 MAIN STREET
Practice Address - Street 2:BOX 1227
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-2300
Practice Address - Fax:907-842-2303
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7333111N00000X
AK123799111N00000X
AK125980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor