Healthcare Provider Details

I. General information

NPI: 1285664672
Provider Name (Legal Business Name): CHARLES WILLIAM LINDQUIST D.C., DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S BROADWAY
GREENVILLE OH
45331-1929
US

IV. Provider business mailing address

607 S BROADWAY ST
GREENVILLE OH
45331-1929
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-7663
  • Fax: 937-547-9175
Mailing address:
  • Phone: 937-548-7663
  • Fax: 937-547-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number970
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: