Provider Demographics
NPI:1417009960
Name:MCCANDLESS, CHARLES ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERIC
Last Name:MCCANDLESS
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 1:21 NORTHGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:PA
Mailing Address - Zip Code:16037-9257
Mailing Address - Country:US
Mailing Address - Phone:724-452-0878
Mailing Address - Fax:724-824-4163
Practice Address - Street 1:21 NORTHGATE PLZ
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:PA
Practice Address - Zip Code:16037-9257
Practice Address - Country:US
Practice Address - Phone:724-452-0878
Practice Address - Fax:724-824-4163
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006270-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01539615Medicaid
PAU57836Medicare UPIN
PA799188Medicare ID - Type Unspecified