Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH 3752 | FL |
N | 111NN0400X | Neurology | CH3752 | FL |
NPI | 1497747869 |
---|---|
Provider Name | Charles Richard Price |
First Address | Brooksville, FL 34601-3116 |
Second Address | Brooksville, FL 34601-3116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 03/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001552100 | (05) | FL |
4406861 | UNITED HEALTHCARE (01) | FL |
88731 | BCBS (01) | FL |
CH 0003752 | WORK COMP (01) | FL |
T55940 | (02) |