Provider Demographics
NPI:1689699779
Name:CARROLL, DARRELL B (DC)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:B
Last Name:CARROLL
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 1:14520 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4317
Mailing Address - Country:US
Mailing Address - Phone:216-227-1490
Mailing Address - Fax:216-712-7490
Practice Address - Street 1:14520 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4317
Practice Address - Country:US
Practice Address - Phone:162-271-4902
Practice Address - Fax:216-712-7490
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE 004781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH29076OtherMEDICAL MUTUAL
MO240941OtherHEALTHLINK
MO4732OtherBLUE CROSS BLUE SHIELD MO
MO240941OtherHEALTHLINK