Provider Demographics
NPI:1497191076
Name:CORRECTIVE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC, PLLC
Other - Org Name:MICHAEL CARNES, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-849-1586
Mailing Address - Street 1:595 ROUTE 25A
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2646
Mailing Address - Country:US
Mailing Address - Phone:631-849-1586
Mailing Address - Fax:631-849-1587
Practice Address - Street 1:595 ROUTE 25A
Practice Address - Street 2:SUITE 2B
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2646
Practice Address - Country:US
Practice Address - Phone:631-849-1586
Practice Address - Fax:631-849-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011590-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX011590-1OtherSTATE LICENSE