=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154329480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE CHARLTON D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | W62N263 WASHINGTON AVE
-----------------------------------------------------
City | CEDARBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53012-2736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-375-3100
-----------------------------------------------------
Fax | 414-352-4755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | W62N263 WASHINGTON AVE
-----------------------------------------------------
City | CEDARBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53012-2736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-375-3100
-----------------------------------------------------
Fax | 414-352-4755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC26693
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3677-012
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------