Provider Demographics
NPI:1912279605
Name:CHARCHAN, ADAM JOE MANLEY (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOE MANLEY
Last Name:CHARCHAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 S CEDAR ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-2080
Mailing Address - Country:US
Mailing Address - Phone:517-244-7787
Mailing Address - Fax:517-244-0578
Practice Address - Street 1:1103 S CEDAR ST STE 300
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-2080
Practice Address - Country:US
Practice Address - Phone:517-244-7787
Practice Address - Fax:517-244-0578
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist