Provider Demographics
NPI:1841389079
Name:JEAN-CHARLES, KENTIA
Entity Type:Individual
Prefix:
First Name:KENTIA
Middle Name:
Last Name:JEAN-CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260-03 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1345
Mailing Address - Country:US
Mailing Address - Phone:718-360-9603
Mailing Address - Fax:718-502-8332
Practice Address - Street 1:26003 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1345
Practice Address - Country:US
Practice Address - Phone:718-360-9603
Practice Address - Fax:718-502-8332
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor