Provider Demographics
NPI:1477667624
Name:CARROLL, DEREK JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:JOSEPH
Last Name:CARROLL
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 1:303 DILLINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3316
Mailing Address - Country:US
Mailing Address - Phone:508-540-2271
Mailing Address - Fax:508-548-7754
Practice Address - Street 1:303 DILLINGHAM AVE STE B
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3316
Practice Address - Country:US
Practice Address - Phone:508-540-2271
Practice Address - Fax:508-548-7754
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49108Medicare ID - Type Unspecified