Provider Demographics
NPI:1346567120
Name:CHARLESTON, DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CHARLESTON
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 1:1055 S CONGRESS AVE
Mailing Address - Street 2:1
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6001
Mailing Address - Country:US
Mailing Address - Phone:561-278-9005
Mailing Address - Fax:954-509-7590
Practice Address - Street 1:1055 S CONGRESS AVE
Practice Address - Street 2:1
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6001
Practice Address - Country:US
Practice Address - Phone:561-278-9005
Practice Address - Fax:954-509-7590
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8492111N00000X
GACHIR008594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor