Provider Demographics
NPI:1821395401
Name:BELANGER, CHARLES ALFRED III (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALFRED
Last Name:BELANGER
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1626
Mailing Address - Country:US
Mailing Address - Phone:510-215-9525
Mailing Address - Fax:510-215-9525
Practice Address - Street 1:1620 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-1626
Practice Address - Country:US
Practice Address - Phone:510-215-9525
Practice Address - Fax:510-215-9525
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist