Provider Demographics
NPI:1497828347
Name:CHARLES R NEBEL DC PC
Entity Type:Organization
Organization Name:CHARLES R NEBEL DC PC
Other - Org Name:CHIROPRACTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:NEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-794-9000
Mailing Address - Street 1:340 FRANKLIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-1164
Mailing Address - Country:US
Mailing Address - Phone:724-794-9000
Mailing Address - Fax:724-794-9001
Practice Address - Street 1:340 FRANKLIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-1164
Practice Address - Country:US
Practice Address - Phone:724-794-9000
Practice Address - Fax:724-794-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006924L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021724OtherASHN
PACH251021OtherBC BS
PACH251021OtherBC BS
PA901224Medicare ID - Type Unspecified