MEDICARE: DR. CHARLES VENEZIA JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC004462L	PA

General Provider Information

NPI Number	:	1154490431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES VENEZIA JR.

Provider Business Mailing Address
First Line	:	1104 PAWLINGS RD
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-2265
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 PAWLINGS RD
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-2265
Country	:	US
Telephone Number	:	610-650-7717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CHARLES VENEZIA JR. ” Practice Location

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