Provider Demographics
NPI:1730103870
Name:CARNIVALE, RICHARD L (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:CARNIVALE
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 1:4140 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5816
Mailing Address - Country:US
Mailing Address - Phone:954-739-3331
Mailing Address - Fax:954-792-4520
Practice Address - Street 1:4140 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5816
Practice Address - Country:US
Practice Address - Phone:954-739-3331
Practice Address - Fax:954-792-4520
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBK419ZMedicare PIN