Provider Demographics
NPI:1336160092
Name:CHARLES A MAURER DC PC
Entity Type:Organization
Organization Name:CHARLES A MAURER DC PC
Other - Org Name:FAMILY BACK AND NECK CARE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:417-889-2225
Mailing Address - Street 1:3100 S NATIONAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7347
Mailing Address - Country:US
Mailing Address - Phone:417-889-2225
Mailing Address - Fax:417-889-1253
Practice Address - Street 1:3100 S NATIONAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7347
Practice Address - Country:US
Practice Address - Phone:417-889-2225
Practice Address - Fax:417-889-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000006508111N00000X
MO2006014817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1316904352OtherINDIVIDUAL NPI
MO123088OtherACA
MO609614OtherACN
MO18140OtherBLUE CROSS BLUE SHIELD
MO1235166455OtherINDIVIDUAL NPI
MO=========OtherTAX ID
MO18140OtherBLUE CROSS BLUE SHIELD
MO990001571Medicare ID - Type Unspecified