Provider Demographics
NPI:1265603419
Name:DUGAN, CHARLES C II (DC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:C
Last Name:DUGAN
Suffix:II
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 1:6309 CORPORATE CT
Mailing Address - Street 2:STE A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3538
Mailing Address - Country:US
Mailing Address - Phone:239-433-1011
Mailing Address - Fax:239-433-3737
Practice Address - Street 1:6309 CORPORATE CT
Practice Address - Street 2:STE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3538
Practice Address - Country:US
Practice Address - Phone:239-433-1011
Practice Address - Fax:239-433-3737
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor