Healthcare Provider Details

I. General information

NPI: 1558307397
Provider Name (Legal Business Name): ERIC ALLAN CHANDLEY PA-C, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/25/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19485 OLD JETTON RD STE 210 SUITE 210
CORNELIUS NC
28031-6592
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-1830
  • Fax: 704-316-1835
Mailing address:
  • Phone: 704-316-1830
  • Fax: 704-316-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2389
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1042
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001000344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: