Provider Demographics
NPI:1538379979
Name:CHARLES, DOMINIC D (DC)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:D
Last Name:CHARLES
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:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-6337
Mailing Address - Country:US
Mailing Address - Phone:734-241-1811
Mailing Address - Fax:734-241-4685
Practice Address - Street 1:1460 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4210
Practice Address - Country:US
Practice Address - Phone:734-241-1811
Practice Address - Fax:734-241-4685
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor