Provider Demographics
NPI:1932339918
Name:BADGER, CHARLES LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEWIS
Last Name:BADGER
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 1:2451 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5790
Mailing Address - Country:US
Mailing Address - Phone:702-233-2225
Mailing Address - Fax:702-233-3508
Practice Address - Street 1:2451 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5790
Practice Address - Country:US
Practice Address - Phone:702-233-2225
Practice Address - Fax:702-233-3508
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
12073009OtherCAQH