Provider Demographics
NPI:1891878443
Name:CHARBONEAU, DOUGLAS MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:CHARBONEAU
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 1:35945 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3070
Mailing Address - Country:US
Mailing Address - Phone:440-327-0338
Mailing Address - Fax:
Practice Address - Street 1:35945 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3070
Practice Address - Country:US
Practice Address - Phone:440-327-0338
Practice Address - Fax:440-327-0441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1127111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH0574082Medicare ID - Type Unspecified
OHT48265Medicare UPIN