Provider Demographics
NPI:1851539118
Name:WISEMAN, CARMEL DEKEL (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:CARMEL
Middle Name:DEKEL
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13988 NEW BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3502
Mailing Address - Country:US
Mailing Address - Phone:240-460-5150
Mailing Address - Fax:240-342-3434
Practice Address - Street 1:10807 MAIN ST
Practice Address - Street 2:800
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4730
Practice Address - Country:US
Practice Address - Phone:240-460-5150
Practice Address - Fax:240-342-3434
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556504111NP0017X
MDS03521111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor