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Individual

CHARLES KIRCHEM IV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
12371 HIGHWAY 90, SUITE D, LULING, LA 70070-5114
(985) 331-1001
(985) 331-1005
Mailing address
12371 HWY. 90, SUITE D, LULING, LA 70070
(985) 331-1001
(985) 331-1005

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
07655
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2113712
LA
Enumeration date
09/11/2009
Last updated
08/18/2010
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