Provider Demographics
NPI:1013737972
Name:CHANEY, CHARLES EDWARD JR
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:CHANEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 ROYAL OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1710
Mailing Address - Country:US
Mailing Address - Phone:216-903-0128
Mailing Address - Fax:
Practice Address - Street 1:17220 OLYMPIA RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1423
Practice Address - Country:US
Practice Address - Phone:216-903-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus