MEDICARE: DR. CHARLES THOMAS CUNNINGHAM 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	DC004881L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CU721867	OTHER	PA	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1891848313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES THOMAS CUNNINGHAM D.C.

Provider Business Mailing Address
First Line	:	4055 MONROEVILLE BLVD
Second Line	:	SUITE 130
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-2522
Country	:	US
Telephone Number	:	412-373-2886
Fax Number	:	412-373-2887

Provider Business Practice Location Address
First Line	:	4055 MONROEVILLE BLVD
Second Line	:	SUITE 130
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-2522
Country	:	US
Telephone Number	:	412-373-2886
Fax Number	:	412-373-2887

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. CHARLES THOMAS CUNNINGHAM D.C.” Practice Location

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