Provider Demographics
NPI:1689778011
Name:CHARNEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CHARNEY CHIROPRACTIC LLC
Other - Org Name:ADVANCED FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-726-2000
Mailing Address - Street 1:3076 EAGLE VALLEY RD.
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-1626
Mailing Address - Country:US
Mailing Address - Phone:570-726-2000
Mailing Address - Fax:570-726-8012
Practice Address - Street 1:3076 EAGLE VALLEY RD.
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1626
Practice Address - Country:US
Practice Address - Phone:570-726-2000
Practice Address - Fax:570-726-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009076111N00000X
PAAJ008899111N00000X
PADC009328111N00000X
PAAJ009137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112635Medicare PIN