Fandel, Charles E

Fandel, Charles E is an individual health care provider with primary practice located at 1580 E Knox St , Galesburg IL 61401-5300. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Fandel, Charles E can be contacted via phone (309) 343-4418.

Contact Information

Primary practice address
1580 E Knox St Galesburg IL 61401-5300
Phone: (309) 343-4418
Fax: (309) 343-4426
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 038010920 Illinois

Profile Details

NPI number 1902096647
LBN Legal business name Fandel, Charles E
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 30th, 2007
Last updated Apr 23rd, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902096647 NPPES
Illinois Other 07232019 BLUE CROSS/BLUE SHIELD
Illinois MEDICAID 038010920 BLUE CROSS/BLUE SHIELD

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