MEDICARE: DR. CHARLES A HOWARD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5566231-1202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55662311277001	OTHER	UT	BLUE CROSS BLUE SHIELD
2	77124	OTHER	UT	PEHP
3	214909	OTHER	UT	ALTIUS

General Provider Information

NPI Number	:	1174523906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES A HOWARD D.C.

Provider Business Mailing Address
First Line	:	435 S MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1317
Country	:	US
Telephone Number	:	435-283-4069
Fax Number	:	435-283-0372

Provider Business Practice Location Address
First Line	:	435 S MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1317
Country	:	US
Telephone Number	:	435-283-4069
Fax Number	:	435-283-0372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/27/2007

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Directions to “ DR. CHARLES A HOWARD D.C.” Practice Location

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