Healthcare Provider Details

I. General information

NPI: 1982896353
Provider Name (Legal Business Name): C3, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 07/23/2021
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 APACHE CT
SIOUX CITY IA
51104-1504
US

IV. Provider business mailing address

2601 APACHE CT
SIOUX CITY IA
51104-1504
US

V. Phone/Fax

Practice location:
  • Phone: 712-277-9355
  • Fax: 712-277-9366
Mailing address:
  • Phone: 712-277-9355
  • Fax: 712-277-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number06891
License Number StateIA

VIII. Authorized Official

Name: MARK PIERRE CHARTIER
Title or Position: MANAGING PARTNER
Credential:
Phone: 712-277-9355