Provider Demographics
NPI:1376723049
Name:DR. C AROL D MURDOCK
Entity Type:Organization
Organization Name:DR. C AROL D MURDOCK
Other - Org Name:MURDOCK CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MURDOCKDC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-646-0243
Mailing Address - Street 1:PO BOX 6749
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33807-6749
Mailing Address - Country:US
Mailing Address - Phone:863-646-0243
Mailing Address - Fax:863-648-1821
Practice Address - Street 1:203 DORIS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1006
Practice Address - Country:US
Practice Address - Phone:863-646-0243
Practice Address - Fax:863-648-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0761Medicare PIN