Provider Demographics
NPI:1033687702
Name:DR C CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DR C CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CARNIVALE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:954-464-7275
Mailing Address - Street 1:9015 NW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2616
Mailing Address - Country:US
Mailing Address - Phone:954-464-7275
Mailing Address - Fax:
Practice Address - Street 1:416 SE 11TH CT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1144
Practice Address - Country:US
Practice Address - Phone:954-464-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty