Provider Demographics
NPI:1740303130
Name:AFFATATO, CHARLES RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:AFFATATO
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 1:1661 EDGEWATER ST. NW
Mailing Address - Street 2:STE 200
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304
Mailing Address - Country:US
Mailing Address - Phone:503-345-5899
Mailing Address - Fax:503-990-8829
Practice Address - Street 1:1661 EDGEWATER ST. NW
Practice Address - Street 2:STE 200
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304
Practice Address - Country:US
Practice Address - Phone:503-345-5899
Practice Address - Fax:415-243-9605
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27971111N00000X
OR5980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor