Provider Demographics
NPI:1831158377
Name:DINWIDDIE, CHARLES WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAYNE
Last Name:DINWIDDIE
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 1:5129 ACAPOLCA WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-2116
Mailing Address - Country:US
Mailing Address - Phone:502-968-1775
Mailing Address - Fax:502-968-1311
Practice Address - Street 1:5129 ACAPOLCA WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-2116
Practice Address - Country:US
Practice Address - Phone:502-968-1775
Practice Address - Fax:502-968-1311
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6031001Medicare ID - Type Unspecified
KYT54376Medicare UPIN