Provider Demographics
NPI:1790781755
Name:PICKUP, CHARLES W (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:PICKUP
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 1:922 PRESQUE ISLE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-2726
Mailing Address - Country:US
Mailing Address - Phone:724-733-8220
Mailing Address - Fax:724-733-8221
Practice Address - Street 1:1014 UNITY CENTER RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-1857
Practice Address - Country:US
Practice Address - Phone:724-433-6411
Practice Address - Fax:412-704-5797
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004097L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPI610355OtherBC/BS PROVIDER NUMBER PA
PA98169Medicaid
PAPI610355Medicare ID - Type UnspecifiedMEDICARE PROVIDER #