Provider Demographics
NPI:1497801716
Name:SHOCKEY, CHARLES EDMUND II (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDMUND
Last Name:SHOCKEY
Suffix:II
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 1:16 E 48TH ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1017
Mailing Address - Country:US
Mailing Address - Phone:212-206-6400
Mailing Address - Fax:
Practice Address - Street 1:16 E 48TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1017
Practice Address - Country:US
Practice Address - Phone:212-206-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011246-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3708009OtherOXFORD
NY0128203OtherGHI