=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982896353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C3, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2007
-----------------------------------------------------
Last Update Date | 07/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2601 APACHE CT
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51104-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-277-9355
-----------------------------------------------------
Fax | 712-277-9366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2601 APACHE CT
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51104-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-277-9355
-----------------------------------------------------
Fax | 712-277-9366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | MARK PIERRE CHARTIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-277-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 06891
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------