Provider Demographics
NPI:1023180999
Name:CARROLL, BRIAN C (DCPC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-0167
Mailing Address - Country:US
Mailing Address - Phone:631-737-3838
Mailing Address - Fax:631-737-8467
Practice Address - Street 1:1484 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-737-3838
Practice Address - Fax:631-737-8467
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXZCZ71Medicare ID - Type Unspecified