Provider Demographics
NPI:1023182441
Name:WESTON, CHARLES H JR (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:WESTON
Suffix:JR
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 1:712B MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1439
Mailing Address - Country:US
Mailing Address - Phone:864-223-2663
Mailing Address - Fax:
Practice Address - Street 1:712B MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1439
Practice Address - Country:US
Practice Address - Phone:864-223-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1337111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCS1337Medicaid
SCT86080Medicare UPIN