Provider Demographics
NPI:1992795983
Name:MUNDAY, CHARLES A (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:MUNDAY
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 1:6645 N SOCRUM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4182
Mailing Address - Country:US
Mailing Address - Phone:863-853-3000
Mailing Address - Fax:863-859-7640
Practice Address - Street 1:6645 N SOCRUM LOOP RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4182
Practice Address - Country:US
Practice Address - Phone:863-853-3000
Practice Address - Fax:863-859-7640
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051100500Medicaid
T79056Medicare UPIN
22538ZMedicare ID - Type Unspecified