Provider Demographics
NPI:1467631044
Name:CARROLL, AMY JACKSON (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JACKSON
Last Name:CARROLL
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 1:2044 ENERGY DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8722
Mailing Address - Country:US
Mailing Address - Phone:919-780-1551
Mailing Address - Fax:
Practice Address - Street 1:2044 ENERGY DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8722
Practice Address - Country:US
Practice Address - Phone:919-780-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7934111N00000X
NC3967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2340526OtherMEDICARE GROUP
NC5912257Medicaid
NC2340526OtherMEDICARE GROUP