Provider Demographics
NPI:1225115587
Name:CARR, EDWARD E (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:CARR
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 1:2978 SOUTHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2216
Mailing Address - Country:US
Mailing Address - Phone:970-690-9084
Mailing Address - Fax:970-204-1980
Practice Address - Street 1:2978 SOUTHMOOR DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2216
Practice Address - Country:US
Practice Address - Phone:970-690-9084
Practice Address - Fax:970-204-1980
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1457111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4313Medicare PIN