Provider Demographics
NPI:1588793020
Name:GORSUCH, CHARLES RICHARD (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:GORSUCH
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 1:222 WEST ST
Mailing Address - Street 2:SUITE 34
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2455
Mailing Address - Country:US
Mailing Address - Phone:603-357-5700
Mailing Address - Fax:603-357-5151
Practice Address - Street 1:222 WEST ST
Practice Address - Street 2:SUITE 34
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2455
Practice Address - Country:US
Practice Address - Phone:603-357-5700
Practice Address - Fax:603-357-5151
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH643-1001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6846Medicare ID - Type Unspecified