1609845981 NPI number — JOHN S CARR DC

Table of content: JOHN S CARR DC (NPI 1609845981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609845981 NPI number — JOHN S CARR DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
JOHN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1609845981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 E 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLER
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57362-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-853-2230
Provider Business Mailing Address Fax Number:
605-853-3111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLER
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57362-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-853-2230
Provider Business Practice Location Address Fax Number:
605-853-3111
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  595 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0006716 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4999851 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7602523 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7602524 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0082802 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7602084 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7602520 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4999861 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4999756 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7602522 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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