Provider Demographics
NPI:1659985729
Name:CARLTON MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CARLTON MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-679-7676
Mailing Address - Street 1:1640 NEWPORT BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3786
Mailing Address - Country:US
Mailing Address - Phone:949-287-6321
Mailing Address - Fax:949-287-6453
Practice Address - Street 1:1640 NEWPORT BLVD STE 440
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-287-6321
Practice Address - Fax:949-287-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty