Provider Demographics
NPI:1235202185
Name:NEBEL, CHARLES RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RANDALL
Last Name:NEBEL
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 1:340 FRANKLIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-1164
Mailing Address - Country:US
Mailing Address - Phone:724-794-9000
Mailing Address - Fax:724-794-9001
Practice Address - Street 1:340 FRANKLIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-1164
Practice Address - Country:US
Practice Address - Phone:724-794-9000
Practice Address - Fax:724-794-9001
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006924L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021724OtherASHN
PACH257021OtherBCBS
PA901224Medicare ID - Type Unspecified
PACH257021OtherBCBS