Provider Demographics
NPI:1831394147
Name:ANTOURI, CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:ANTOURI
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 1:159 CATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-273-6192
Mailing Address - Fax:530-419-2585
Practice Address - Street 1:159 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-273-6192
Practice Address - Fax:530-273-6565
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29210111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation