1396085312 NPI number — CARROLL CHIROPRACTIC CLINIC, P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396085312 NPI number — CARROLL CHIROPRACTIC CLINIC, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARROLL CHIROPRACTIC CLINIC, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396085312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 N SLAPPEY BLVD
Provider Second Line Business Mailing Address:
PMB 143
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31701-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-432-5617
Provider Business Mailing Address Fax Number:
229-883-0108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 WHISPERING PINES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31707-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-432-5617
Provider Business Practice Location Address Fax Number:
229-883-0108
Provider Enumeration Date:
02/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
229-432-5617

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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