Provider Demographics
NPI:1295919777
Name:MCMAHON, CHARITY JOY (DC)
Entity type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:JOY
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHARITY
Other - Middle Name:JOY
Other - Last Name:ROOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5973 EXECUTIVE DR 3
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5336
Mailing Address - Country:US
Mailing Address - Phone:608-274-7090
Mailing Address - Fax:608-274-4075
Practice Address - Street 1:5973 EXECUTIVE DR 3
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5336
Practice Address - Country:US
Practice Address - Phone:608-274-7090
Practice Address - Fax:608-274-4075
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4369-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor