Provider Demographics
NPI:1497725568
Name:CAROTHERS, W. BRETT (DC)
Entity Type:Individual
Prefix:
First Name:W. BRETT
Middle Name:
Last Name:CAROTHERS
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 1:3344 ROUTE 130
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1238
Mailing Address - Country:US
Mailing Address - Phone:412-374-1400
Mailing Address - Fax:412-374-1416
Practice Address - Street 1:3344 ROUTE 130
Practice Address - Street 2:SUITE C
Practice Address - City:HARRISON CITY
Practice Address - State:PA
Practice Address - Zip Code:15636-1238
Practice Address - Country:US
Practice Address - Phone:412-374-1400
Practice Address - Fax:412-374-1416
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003606-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU08236Medicare UPIN
PA0000516844Medicare ID - Type Unspecified