Active NPI
Charles David Coram, D.C.
- Sports Physician Chiropractor
- Ottumwa, IA
National Provider Identifier
1376659490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- A06164
- Practice address
- 1941 Albia Rd
Ottumwa, IA 52501-3708 - Phone
- (641) 682-3993
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | A06164 | IA | Primary |
Addresses
Primary practice location
1941 Albia Rd
Ottumwa, IA 52501-3708
Mailing address
1941 Albia Rd
Ottumwa, IA 52501-3708
Phone (641) 682-3993
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0185058 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A06164 | IA | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376659490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1941 ALBIA RD",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525013708",
"telephone_number": "641-682-3993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1941 ALBIA RD",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525013708",
"telephone_number": "641-682-3993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORAM",
"first_name": "CHARLES",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "IA",
"license": "A06164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0185058",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ottumwa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.