Provider Demographics
NPI:1881747400
Name:CHARLTON CHIROPRACTIC
Entity type:Organization
Organization Name:CHARLTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-332-0100
Mailing Address - Street 1:1028 N KINGSHIGHWAY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3503
Mailing Address - Country:US
Mailing Address - Phone:573-332-0100
Mailing Address - Fax:573-332-0230
Practice Address - Street 1:1028 N KINGSHIGHWAY ST STE 3
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3503
Practice Address - Country:US
Practice Address - Phone:573-332-0100
Practice Address - Fax:573-332-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2437Medicare PIN