Provider Demographics
NPI:1912971136
Name:SALLAHIAN, CHARLES A (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:SALLAHIAN
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 1:4 AMARILLO DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1301
Mailing Address - Country:US
Mailing Address - Phone:845-623-5610
Mailing Address - Fax:212-213-3929
Practice Address - Street 1:4 AMARILLO DR
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1301
Practice Address - Country:US
Practice Address - Phone:845-623-5610
Practice Address - Fax:212-213-3929
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3403111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
X19092Medicare PIN
X19091Medicare PIN
T52435Medicare UPIN