Provider Demographics
NPI:1881623502
Name:CHARNSTROM, DANIEL ROY (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROY
Last Name:CHARNSTROM
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:PO BOX 71395
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1007
Mailing Address - Country:US
Mailing Address - Phone:602-788-7777
Mailing Address - Fax:602-867-9185
Practice Address - Street 1:20624 N CAVE CREEK RD
Practice Address - Street 2:STE #140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4453
Practice Address - Country:US
Practice Address - Phone:602-788-7777
Practice Address - Fax:602-867-9185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0930360OtherBLUE CROSS/BLUE SHIELD
AZ65893Medicare ID - Type Unspecified
AZU54022Medicare UPIN
AZ0930360OtherBLUE CROSS/BLUE SHIELD