Provider Demographics
NPI:1922760719
Name:VIA, CHARLIE NEAL (DC)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:NEAL
Last Name:VIA
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 1:3566 N HIGHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7890
Mailing Address - Country:US
Mailing Address - Phone:731-664-8000
Mailing Address - Fax:731-664-8100
Practice Address - Street 1:3566 N HIGHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7890
Practice Address - Country:US
Practice Address - Phone:731-664-8000
Practice Address - Fax:731-664-8100
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor