Provider Demographics
NPI:1932593696
Name:CHARLES L. JAHTLOHEE ROGERS ANIKUTANI HEAD PRIEST
Entity Type:Organization
Organization Name:CHARLES L. JAHTLOHEE ROGERS ANIKUTANI HEAD PRIEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PRIEST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-858-2951
Mailing Address - Street 1:9250 MC GREGOR LANE
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620
Mailing Address - Country:US
Mailing Address - Phone:512-858-2951
Mailing Address - Fax:
Practice Address - Street 1:9250 MCGREGOR LN
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3505
Practice Address - Country:US
Practice Address - Phone:512-858-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ175F00000X
282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty