MEDICARE: DR. CHARLES W. PICKUP D.C.

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	DC004097L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PI610355	OTHER	PA	BC/BS PROVIDER NUMBER PA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790781755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES W. PICKUP D.C.

Provider Business Mailing Address
First Line	:	922 PRESQUE ISLE DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15239-2726
Country	:	US
Telephone Number	:	724-733-8220
Fax Number	:	724-733-8221

Provider Business Practice Location Address
First Line	:	1014 UNITY CENTER RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15239-1857
Country	:	US
Telephone Number	:	724-433-6411
Fax Number	:	412-704-5797

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	04/08/2016

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Directions to “ DR. CHARLES W. PICKUP D.C.” Practice Location

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