Provider Demographics
NPI:1841261500
Name:COCHRAN, CHARLES MCCANN II (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MCCANN
Last Name:COCHRAN
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-0111
Mailing Address - Country:US
Mailing Address - Phone:812-829-2241
Mailing Address - Fax:812-829-2242
Practice Address - Street 1:159 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1521
Practice Address - Country:US
Practice Address - Phone:812-829-2241
Practice Address - Fax:812-829-2242
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000785A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN610310AMedicare ID - Type Unspecified
INT83594Medicare UPIN