Provider Demographics
NPI:1891848313
Name:CUNNINGHAM, CHARLES THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:CUNNINGHAM
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 1:4055 MONROEVILLE BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2522
Mailing Address - Country:US
Mailing Address - Phone:412-373-2886
Mailing Address - Fax:412-373-2887
Practice Address - Street 1:4055 MONROEVILLE BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2522
Practice Address - Country:US
Practice Address - Phone:412-373-2886
Practice Address - Fax:412-373-2887
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004881L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACU721867OtherBCBS PROVIDER NUMBER
PACU721867OtherBCBS PROVIDER NUMBER