Provider Demographics
NPI:1386216273
Name:CHARNEY, JUSTIN (DC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:CHARNEY
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 1:100 E CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1703
Mailing Address - Country:US
Mailing Address - Phone:610-532-3401
Mailing Address - Fax:
Practice Address - Street 1:100 EAST CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078
Practice Address - Country:US
Practice Address - Phone:215-901-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011670111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor