Provider Demographics
NPI:1346392784
Name:DECAROL, ROLAND (DC)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:DECAROL
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 1:1653 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5111
Mailing Address - Country:US
Mailing Address - Phone:315-732-7979
Mailing Address - Fax:
Practice Address - Street 1:1653 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5111
Practice Address - Country:US
Practice Address - Phone:315-732-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56816BMedicare ID - Type Unspecified