Provider Demographics
NPI:1578595252
Name:KRIEGER, CHARLES A (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:KRIEGER
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 1:3804 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3800
Mailing Address - Country:US
Mailing Address - Phone:718-726-0040
Mailing Address - Fax:718-726-0020
Practice Address - Street 1:3804 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3800
Practice Address - Country:US
Practice Address - Phone:718-726-0040
Practice Address - Fax:718-726-0020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400000228Medicare PIN