Provider Demographics
NPI:1871639443
Name:SAMSON, CHARLES EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:SAMSON
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 1:755 GRATTAN ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1238
Mailing Address - Country:US
Mailing Address - Phone:413-532-1040
Mailing Address - Fax:413-536-0320
Practice Address - Street 1:755 GRATTAN ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1238
Practice Address - Country:US
Practice Address - Phone:413-532-1040
Practice Address - Fax:413-536-0320
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASA Y35635OtherBLUECROSS BLUESHIELD MA
MA1605186Medicaid
MA1605186Medicaid