Provider Demographics
NPI:1699281394
Name:VADEN, CHARLES DANIEL (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DANIEL
Last Name:VADEN
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 1:2695 PATTERSON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8815
Mailing Address - Country:US
Mailing Address - Phone:970-243-1388
Mailing Address - Fax:
Practice Address - Street 1:2695 PATTERSON RD STE 3
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8815
Practice Address - Country:US
Practice Address - Phone:970-243-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor