Provider Demographics
NPI:1871659029
Name:DESCALZI, CHARLES C (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:DESCALZI
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 1:11600 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1917
Mailing Address - Country:US
Mailing Address - Phone:301-942-2200
Mailing Address - Fax:301-942-2202
Practice Address - Street 1:11600 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1917
Practice Address - Country:US
Practice Address - Phone:301-942-2200
Practice Address - Fax:301-942-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4271202OtherAETNA
R41273401OtherBCBS
E6630001OtherBCBS
R41273401OtherBCBS
191928Medicare ID - Type Unspecified