Provider Demographics
NPI:1124031547
Name:CARROLL, MARK POWERS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:POWERS
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5390 PARK CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-5923
Mailing Address - Country:US
Mailing Address - Phone:239-598-9599
Mailing Address - Fax:239-598-3072
Practice Address - Street 1:5390 PARK CENTRAL CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-5923
Practice Address - Country:US
Practice Address - Phone:239-598-9599
Practice Address - Fax:239-598-3072
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70748Medicare ID - Type Unspecified