Healthcare Provider Details

I. General information

NPI: 1710945274
Provider Name (Legal Business Name): JOHN CHARLES CARLS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 VASSAR DRIVE
KALAMAZOO MI
49001
US

IV. Provider business mailing address

952 VASSAR DRIVE
KALAMAZOO MI
49001
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-7946
  • Fax: 269-344-6196
Mailing address:
  • Phone: 269-344-7946
  • Fax: 269-344-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberJC002732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: