Provider Demographics
NPI:1013973072
Name:STERMETZ, CHARLES KEVIN (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEVIN
Last Name:STERMETZ
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 1:2133 E WARNER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3492
Mailing Address - Country:US
Mailing Address - Phone:480-820-6695
Mailing Address - Fax:480-820-6696
Practice Address - Street 1:2133 E WARNER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3492
Practice Address - Country:US
Practice Address - Phone:480-820-6695
Practice Address - Fax:480-820-6696
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100326Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION
AZU05761Medicare UPIN