Provider Demographics
NPI:1134206808
Name:CHARLES, MATTHEW J (DC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:CHARLES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 UNION ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1450
Mailing Address - Country:US
Mailing Address - Phone:724-882-7963
Mailing Address - Fax:
Practice Address - Street 1:96 UNION ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1450
Practice Address - Country:US
Practice Address - Phone:724-882-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001688111N00000X
MA3226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11618170OtherCAQH
CT050001688CT01OtherANTHEM BLUE CROSS
CTV10373Medicare UPIN
CT350001504Medicare ID - Type UnspecifiedMEDICARE