Provider Demographics
NPI:1407943251
Name:CHARONIS, ANGELO GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:GEORGE
Last Name:CHARONIS
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 1:250C TWIN DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1402
Mailing Address - Country:US
Mailing Address - Phone:650-631-1500
Mailing Address - Fax:
Practice Address - Street 1:250C TWIN DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1402
Practice Address - Country:US
Practice Address - Phone:650-631-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92563Medicare UPIN
DC-0279020Medicare ID - Type Unspecified