Provider Demographics
NPI:1942366000
Name:CARROLL, PATRICE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:ANNE
Last Name:CARROLL
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 1:106 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6004
Mailing Address - Country:US
Mailing Address - Phone:518-587-0057
Mailing Address - Fax:518-584-3715
Practice Address - Street 1:106 WEST AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6004
Practice Address - Country:US
Practice Address - Phone:518-587-0057
Practice Address - Fax:518-584-3715
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO5065-0DCOtherWORKERS COMPENSATION
NY10013911-6554OtherCDPHP
NYX39861OtherBCBS
NY10013911-6554OtherCDPHP
NYU02490Medicare UPIN
NY350019283Medicare PIN