Provider Demographics
NPI:1174523906
Name:HOWARD, CHARLES A (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:HOWARD
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 1:435 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-1317
Mailing Address - Country:US
Mailing Address - Phone:435-283-4069
Mailing Address - Fax:435-283-0372
Practice Address - Street 1:435 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1317
Practice Address - Country:US
Practice Address - Phone:435-283-4069
Practice Address - Fax:435-283-0372
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5566231-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT55662311277001OtherBLUE CROSS BLUE SHIELD
UT77124OtherPEHP
UT214909OtherALTIUS
UTU89826Medicare UPIN