Provider Demographics
NPI:1730199324
Name:NEWBY, CHARLES E (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:NEWBY
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 1:415 N RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-1442
Mailing Address - Country:US
Mailing Address - Phone:906-265-5175
Mailing Address - Fax:906-265-6575
Practice Address - Street 1:415 N RIVER AVE
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1442
Practice Address - Country:US
Practice Address - Phone:906-265-5175
Practice Address - Fax:906-265-6575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICN003047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P37530Medicare PIN