Provider Demographics
NPI:1912191040
Name:DONOFRIO, CHARLES RALPH (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RALPH
Last Name:DONOFRIO
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 1:31641 AUTO CENTER DR
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4535
Mailing Address - Country:US
Mailing Address - Phone:951-471-3530
Mailing Address - Fax:951-471-3617
Practice Address - Street 1:31641 AUTO CENTER DR
Practice Address - Street 2:SUITE 1-C
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4535
Practice Address - Country:US
Practice Address - Phone:951-471-3530
Practice Address - Fax:951-471-3617
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor