Healthcare Provider Details

I. General information

NPI: 1821282690
Provider Name (Legal Business Name): CHARLES RICHARD CLOSE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26242 S LAKEMONT DR
SUN LAKES AZ
85248-7157
US

IV. Provider business mailing address

26242 S LAKEMONT DR
SUN LAKES AZ
85248-7157
US

V. Phone/Fax

Practice location:
  • Phone: 602-770-2536
  • Fax:
Mailing address:
  • Phone: 602-770-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number6027
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number6027
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6027
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: