Provider Demographics
NPI:1134242357
Name:BARTKUS, CHARLES J (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:BARTKUS
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:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-1633
Mailing Address - Country:US
Mailing Address - Phone:772-913-1982
Mailing Address - Fax:
Practice Address - Street 1:2705 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5068
Practice Address - Country:US
Practice Address - Phone:772-913-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4098111N00000X
CA14819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88879OtherBCBS
59-2217557OtherEIN
65-0530525OtherEIN
FL88879OtherBCBS
FLT88880Medicare UPIN