Provider Demographics
NPI:1316105752
Name:CHARLES W. ROMMELL, D.C., P.C.
Entity type:Organization
Organization Name:CHARLES W. ROMMELL, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-296-1919
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-31
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4160261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC4160Medicare PIN