Provider Demographics
NPI:1568505626
Name:O'NEILL, CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:O'NEILL
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 1:186 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1787
Mailing Address - Country:US
Mailing Address - Phone:606-475-0000
Mailing Address - Fax:606-474-0954
Practice Address - Street 1:186 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1787
Practice Address - Country:US
Practice Address - Phone:606-475-0000
Practice Address - Fax:606-474-0954
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor