Provider Demographics
NPI:1447459078
Name:CHARLES D PRICE
Entity type:Organization
Organization Name:CHARLES D PRICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-268-3313
Mailing Address - Street 1:3120 N CROSS ST
Mailing Address - Street 2:ROBINSON CHIROPRACTIC SERVICES
Mailing Address - City:ROBINSON
Mailing Address - State:IN
Mailing Address - Zip Code:62454
Mailing Address - Country:US
Mailing Address - Phone:618-544-3551
Mailing Address - Fax:
Practice Address - Street 1:102 S SECTION ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-1805
Practice Address - Country:US
Practice Address - Phone:812-268-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN780860Medicare PIN