Provider Demographics
NPI:1508965419
Name:CARRICK, H BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:BRUCE
Last Name:CARRICK
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 1:1309 VEALE RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4609
Mailing Address - Country:US
Mailing Address - Phone:302-478-1443
Mailing Address - Fax:302-478-3107
Practice Address - Street 1:1309 VEALE RD
Practice Address - Street 2:STE 12
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4609
Practice Address - Country:US
Practice Address - Phone:302-478-1443
Practice Address - Fax:302-478-3107
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DET98506Medicare UPIN
DE031546Medicare ID - Type Unspecified