Provider Demographics
NPI:1558307397
Name:CHANDLEY, ERIC ALLAN (PA-C, DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALLAN
Last Name:CHANDLEY
Suffix:
Gender:M
Credentials:PA-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-1830
Mailing Address - Fax:704-316-1835
Practice Address - Street 1:19485 OLD JETTON RD STE 210
Practice Address - Street 2:SUITE 210
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6592
Practice Address - Country:US
Practice Address - Phone:704-316-1830
Practice Address - Fax:704-316-1835
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2389111N00000X
SC1042363A00000X
NC001000344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102026Medicaid
NCNC5440AMedicare PIN