Provider Demographics
NPI:1841479128
Name:DR CHARLES PRICE PA
Entity type:Organization
Organization Name:DR CHARLES PRICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-796-2660
Mailing Address - Street 1:934 CANDLELIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3116
Mailing Address - Country:US
Mailing Address - Phone:352-796-2660
Mailing Address - Fax:352-799-4487
Practice Address - Street 1:934 CANDLELIGHT BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3116
Practice Address - Country:US
Practice Address - Phone:352-796-2660
Practice Address - Fax:352-799-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 3752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002249700Medicaid
FL000TTOtherBCBS
FLDN1277Medicare PIN
FL002249700Medicaid