Provider Demographics
NPI:1831227057
Name:CHILDS, CHARLES MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARTIN
Last Name:CHILDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHUCK
Other - Middle Name:MARTIN
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1330 N INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3393
Mailing Address - Country:US
Mailing Address - Phone:405-366-9355
Mailing Address - Fax:405-366-9393
Practice Address - Street 1:1330 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3393
Practice Address - Country:US
Practice Address - Phone:405-366-9355
Practice Address - Fax:405-366-9393
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU93189Medicare UPIN