Provider Demographics
NPI:1881733129
Name:STEETS, CHARLES JOHN JR (DC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOHN
Last Name:STEETS
Suffix:JR
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 1:3566 N. HIGHLAND AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-664-8000
Mailing Address - Fax:731-664-8100
Practice Address - Street 1:3566 N HIGHLAND AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-664-8000
Practice Address - Fax:731-664-8100
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN806111N00000X
TNDC0000000806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3040246OtherBLUE CROSS BLUE SHIELD
1881733129Medicare PIN
TN3040246OtherBLUE CROSS BLUE SHIELD
TNU30340Medicare UPIN