Provider Demographics
NPI:1902013758
Name:PRICE, CHARISE A (BSDC)
Entity Type:Individual
Prefix:
First Name:CHARISE
Middle Name:A
Last Name:PRICE
Suffix:
Gender:F
Credentials:BSDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1336
Mailing Address - Country:US
Mailing Address - Phone:417-732-2682
Mailing Address - Fax:
Practice Address - Street 1:113 E GRANT ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1336
Practice Address - Country:US
Practice Address - Phone:417-732-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOCE005730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor