Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 6027 | AZ |
N | 111NN1001X | Nutrition | 6027 | AZ |
Y | 111NS0005X | Chiropractic Sports Physician | 6027 | AZ |
NPI | 1821282690 |
---|---|
Provider Name | Dr. Charles Richard Close |
First Address | Sun Lakes, AZ 85248-7157 |
Second Address | Sun Lakes, AZ 85248-7157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |