Provider Demographics
NPI:1760571541
Name:IAIZZI, CAROL E (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:IAIZZI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 RARITAN RD
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3378
Mailing Address - Country:US
Mailing Address - Phone:908-653-1440
Mailing Address - Fax:908-653-0177
Practice Address - Street 1:1130 RARITAN RD
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3378
Practice Address - Country:US
Practice Address - Phone:908-653-1440
Practice Address - Fax:908-653-0177
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC4916111N00000X
NYX007165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU37592Medicare UPIN
NJIA553407Medicare ID - Type Unspecified
NYX49391Medicare UPIN