Provider Demographics
NPI:1982983920
Name:CHARLES, MARTINE (DC)
Entity type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 SALEM CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2809
Mailing Address - Country:US
Mailing Address - Phone:850-328-0424
Mailing Address - Fax:850-324-0425
Practice Address - Street 1:177 SALEM CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2809
Practice Address - Country:US
Practice Address - Phone:850-328-0424
Practice Address - Fax:850-328-0425
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor