Provider Demographics
NPI:1023033453
Name:NEAL, CHARLES B (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:NEAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2629 CREIGHTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7343
Mailing Address - Country:US
Mailing Address - Phone:850-479-2700
Mailing Address - Fax:850-478-1631
Practice Address - Street 1:2629 CREIGHTON RD STE 1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7343
Practice Address - Country:US
Practice Address - Phone:850-479-2700
Practice Address - Fax:850-478-1631
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003725111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0003725OtherSTATE LICENSE
FL593484706OtherTAX ID
FL88835Medicare ID - Type Unspecified
FLT55989Medicare UPIN