Healthcare Provider Details

I. General information

NPI: 1932393063
Provider Name (Legal Business Name): CHARLES MICHEAL MCCABE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S. LENOLA RD STE 205 TALL OAKS BLDG I
MAPLE SHADE NJ
08052
US

IV. Provider business mailing address

200 CHESTER AVE UNIT #660
MOORESTOWN NJ
08057
US

V. Phone/Fax

Practice location:
  • Phone: 856-866-0711
  • Fax: 856-344-1887
Mailing address:
  • Phone: 856-866-0711
  • Fax: 856-344-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00382400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: