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General NPI Number Information
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NPI Number | 1770176059
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Entity Type | Individual
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Provider Name | ANDRE CHARLES DC
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Gender | Male
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 11440 W BROAD ST
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City | GLEN ALLEN
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State | VA
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Zip | 23060-5821
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Country | US
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Telephone | 301-841-5077
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 COLONY VILLAGE TER APT 308
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-3365
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Country | US
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Telephone | 850-276-0774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104557760
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License Number State | VA
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