Provider Demographics
NPI:1972686103
Name:CARBONE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:CARBONE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-296-4446
Mailing Address - Street 1:82-86 WOLCOTT HILL RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1252
Mailing Address - Country:US
Mailing Address - Phone:860-296-4446
Mailing Address - Fax:860-296-0041
Practice Address - Street 1:82-86 WOLCOTT HILL RD
Practice Address - Street 2:SUITE #1
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1252
Practice Address - Country:US
Practice Address - Phone:860-296-4446
Practice Address - Fax:860-296-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12140Medicare UPIN
CTC02463Medicare ID - Type Unspecified