Provider Demographics
NPI:1124401302
Name:CARLTON CARE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CARLTON CARE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALENA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-301-8323
Mailing Address - Street 1:6400 MANATEE AVE W STE L103
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2364
Mailing Address - Country:US
Mailing Address - Phone:941-301-8323
Mailing Address - Fax:941-792-2800
Practice Address - Street 1:6400 MANATEE AVE W STE L103
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2364
Practice Address - Country:US
Practice Address - Phone:941-301-8323
Practice Address - Fax:941-792-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC643-013-71-545-0OtherDRIVER LICENSE
FLU95170Medicare UPIN