Provider Demographics
NPI:1083768782
Name:CARLTON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CARLTON CHIROPRACTIC PC
Other - Org Name:CARLTON HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:SHUMATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-335-9149
Mailing Address - Street 1:8805 SUDLEY ROAD
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-335-9149
Mailing Address - Fax:703-335-9004
Practice Address - Street 1:8805 SUDLEY ROAD
Practice Address - Street 2:SUITE 200 A
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-335-9149
Practice Address - Fax:703-335-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000899111N00000X
VA2305004018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03495Medicare PIN