Provider Demographics
NPI:1770176059
Name:CHARLES, ANDRE (DC)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:CHARLES
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 1:2700 COLONY VILLAGE TER APT 308
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-3365
Mailing Address - Country:US
Mailing Address - Phone:850-276-0774
Mailing Address - Fax:
Practice Address - Street 1:11440 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5821
Practice Address - Country:US
Practice Address - Phone:301-841-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor