Provider Demographics
NPI:1295956530
Name:SOFFER, CHARLES ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALLAN
Last Name:SOFFER
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 1:3201 SE SANTA BARBARA PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4169
Mailing Address - Country:US
Mailing Address - Phone:239-542-8009
Mailing Address - Fax:
Practice Address - Street 1:1722 DEL PRADO BLVD S
Practice Address - Street 2:#4
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5525
Practice Address - Country:US
Practice Address - Phone:239-542-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380189600Medicaid
FL22490Medicare ID - Type Unspecified
FL380189600Medicaid