Provider Demographics
NPI:1982828117
Name:TERRANOVA, CHARLES MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:TERRANOVA
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 1:167 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-2009
Mailing Address - Country:US
Mailing Address - Phone:201-641-1600
Mailing Address - Fax:201-807-0231
Practice Address - Street 1:167 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-2009
Practice Address - Country:US
Practice Address - Phone:201-641-1600
Practice Address - Fax:201-807-0231
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009971111N00000X
NJ38MC00665500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU83094Medicare UPIN
NY06797Medicare ID - Type UnspecifiedMEDICARE PIN GHI
NYXOH111Medicare ID - Type UnspecifiedMEDICARE PIN EMPIRE
NJ127574YYCMedicare PIN