Active NPI
Andre Charles, DC
- Chiropractor
- Glen Allen, VA
National Provider Identifier
1770176059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 0104557760
- Practice address
- 11440 W Broad St
Glen Allen, VA 23060-5821 - Phone
- (301) 841-5077
- NPI assigned
- Feb 17, 2021
- Last updated
- Mar 22, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 0104557760 | VA | Primary |
Addresses
Primary practice location
11440 W Broad St
Glen Allen, VA 23060-5821
Mailing address
2700 Colony Village Ter Apt 308
North Chesterfield, VA 23237-3365
Phone (850) 276-0774
Other practice location 1
11446 W Broad St
Glen Allen, VA 23060-5821
Phone (301) 841-5077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0104557760 | VA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fedinjry Services | Past | Accepting new patients | |
| Parker University | Chiropractor | Past | Accepting new patients |
| Fedserve | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/23964/brand/1/csg/1/fhir/r4
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Richmond, VA
- NPI 1629783824
-
- Physical Therapy Clinic/Center
- Richmond, VA
- NPI 1881308682
-
dba Dallas or Irving Chiropractic Wellness Clinic
- Chiropractor
- Dallas, TX
- NPI 1669582680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679443200000",
"number": "1770176059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 COLONY VILLAGE TER APT 308",
"city": "NORTH CHESTERFIELD",
"state": "VA",
"postal_code": "232373365",
"telephone_number": "850-276-0774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11440 W BROAD ST",
"city": "GLEN ALLEN",
"state": "VA",
"postal_code": "230605821",
"telephone_number": "301-841-5077"
}
],
"practiceLocations": [
{
"address_1": "11446 W Broad St",
"address_purpose": "LOCATION",
"city": "Glen Allen",
"state": "VA",
"postal_code": "230605821",
"country_code": "US",
"telephone_number": "301-841-5077",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHARLES",
"first_name": "ANDRE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-17",
"last_updated": "2023-03-22",
"certification_date": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "VA",
"license": "0104557760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Allen, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.