Provider Demographics
NPI:1700967007
Name:SPERBECK, CHARLES WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:SPERBECK
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 1:1770 N TRACY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2428
Mailing Address - Country:US
Mailing Address - Phone:209-836-5558
Mailing Address - Fax:209-836-5355
Practice Address - Street 1:1770 N TRACY BLVD STE B
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2428
Practice Address - Country:US
Practice Address - Phone:209-836-5558
Practice Address - Fax:209-836-5355
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25026111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0250260Medicare ID - Type Unspecified