Provider Demographics
NPI:1396741559
Name:SROUR, CHARLES (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SROUR
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 1:1948 NE 123RD ST
Mailing Address - Street 2:STE 107
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2800
Mailing Address - Country:US
Mailing Address - Phone:305-891-2520
Mailing Address - Fax:305-891-5754
Practice Address - Street 1:1948 NE 123RD ST
Practice Address - Street 2:STE 107
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2800
Practice Address - Country:US
Practice Address - Phone:305-891-2520
Practice Address - Fax:305-891-5754
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2963ZMedicare PIN
FLV00892Medicare UPIN