Provider Demographics
NPI:1376819219
Name:SORRELL, CARLY F (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:F
Last Name:SORRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6477 CHERRY MEADOW DR SE STE 3
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7351
Mailing Address - Country:US
Mailing Address - Phone:616-322-4984
Mailing Address - Fax:
Practice Address - Street 1:6477 CHERRY MEADOW DR SE STE 3
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7351
Practice Address - Country:US
Practice Address - Phone:616-322-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1646945111N00000X
MI2301009599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor