Provider Demographics
NPI:1215936711
Name:ROMMELL, CHARLES W (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:ROMMELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1670 N KOLB RD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4940
Mailing Address - Country:US
Mailing Address - Phone:520-296-1919
Mailing Address - Fax:520-296-1919
Practice Address - Street 1:1670 N KOLB RD
Practice Address - Street 2:SUITE 146
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4940
Practice Address - Country:US
Practice Address - Phone:520-296-1919
Practice Address - Fax:520-296-1919
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ122406Medicare PIN