Provider Demographics
NPI:1831467448
Name:MALDONADO, CHARLES ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDREW
Last Name:MALDONADO
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 1:438 MILLS ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 N YORK RD STE 100
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3595
Practice Address - Country:US
Practice Address - Phone:630-654-9300
Practice Address - Fax:630-608-2855
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor