=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871625665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES BORG HAFELE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6527 HAMILTON AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-931-7325
-----------------------------------------------------
Fax | 513-931-7324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6527 HAMILTON AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-931-7325
-----------------------------------------------------
Fax | 513-931-7324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. CHARLES BORG HAFELE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 513-931-7325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0006186
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | OHIO 1564
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------