Provider Demographics
NPI:1386786200
Name:HOFFMAN, CHARLES V (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:V
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 NE 119TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1643
Mailing Address - Country:US
Mailing Address - Phone:760-963-9467
Mailing Address - Fax:760-256-2573
Practice Address - Street 1:11500 NE 119TH ST STE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-1643
Practice Address - Country:US
Practice Address - Phone:760-954-5120
Practice Address - Fax:760-256-2573
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0213650Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAU32764Medicare UPIN