Provider Demographics
NPI:1396051470
Name:ARCHER, CHARLES HENRY IV (DC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HENRY
Last Name:ARCHER
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:4220 CANAL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5996
Mailing Address - Country:US
Mailing Address - Phone:504-252-9182
Mailing Address - Fax:504-265-0187
Practice Address - Street 1:3301 CANAL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6247
Practice Address - Country:US
Practice Address - Phone:504-252-9182
Practice Address - Fax:504-265-0187
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4P8896631Medicare PIN