MEDICARE: DR. ARTHUR LEON CHARETTE DC QME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	23764	CA
2	111NS0005X	Sports Physician Chiropractor	23764	CA
3	111NX0100X	Occupational Health Chiropractor	23764	CA

General Provider Information

NPI Number	:	1689672099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTHUR LEON CHARETTE DC QME

Provider Business Mailing Address
First Line	:	587 5TH ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6831
Country	:	US
Telephone Number	:	707-935-1006
Fax Number	:	707-935-7291

Provider Business Practice Location Address
First Line	:	587 5TH ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6831
Country	:	US
Telephone Number	:	707-935-1006
Fax Number	:	707-935-7291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	10/22/2010

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