Provider Demographics
NPI:1649415985
Name:MARK T. CARRICK, DC
Entity Type:Organization
Organization Name:MARK T. CARRICK, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-479-6988
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08804-0377
Mailing Address - Country:US
Mailing Address - Phone:908-479-6988
Mailing Address - Fax:908-479-6980
Practice Address - Street 1:960 ROUTE 173
Practice Address - Street 2:
Practice Address - City:BLOOMSBURY
Practice Address - State:NJ
Practice Address - Zip Code:08804-3112
Practice Address - Country:US
Practice Address - Phone:908-479-6988
Practice Address - Fax:908-479-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00630800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099929Medicaid
U13037Medicare UPIN
NJ084840Medicare PIN