Provider Demographics
NPI:1003848771
Name:CARROLL CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CARROLL CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-624-9293
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-0544
Mailing Address - Country:US
Mailing Address - Phone:989-624-9293
Mailing Address - Fax:989-624-9294
Practice Address - Street 1:11945 CONQUEST ST
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415
Practice Address - Country:US
Practice Address - Phone:989-624-9293
Practice Address - Fax:989-624-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC009035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01001656OtherHEALTH PLUS
MI0G311860OtherBLUE CROSS BLUE SHIELD
MIAC009035OtherLICENSE
MI=========OtherTAX ID
MI6045980001Medicare NSC
MI0G311860OtherBLUE CROSS BLUE SHIELD
MI0P33980Medicare PIN