Provider Demographics
NPI:1275612756
Name:MCDILL, CHARLES A (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:MCDILL
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 1:12551 NORTH MAIN STREET
Mailing Address - Street 2:P.O. BOX 1044
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-1044
Mailing Address - Country:US
Mailing Address - Phone:706-657-4777
Mailing Address - Fax:706-657-2034
Practice Address - Street 1:12551 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-1044
Practice Address - Country:US
Practice Address - Phone:706-657-4777
Practice Address - Fax:706-657-2034
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU98824Medicare UPIN
GA35ZCHNZMedicare ID - Type Unspecified
TN4078568Medicare UPIN