1689778011 NPI number — CHARNEY CHIROPRACTIC LLC

Table of content: (NPI 1689778011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689778011 NPI number — CHARNEY CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARNEY CHIROPRACTIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689778011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3076 EAGLE VALLEY RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILL HALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17751-1626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-726-2000
Provider Business Mailing Address Fax Number:
570-726-8012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3076 EAGLE VALLEY RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILL HALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17751-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-726-2000
Provider Business Practice Location Address Fax Number:
570-726-8012
Provider Enumeration Date:
09/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHARNEY
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
570-726-2000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009076 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: AJ008899 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC009328 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: AJ009137 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)