Provider Demographics
NPI:1184252520
Name:VAN BLARICUM, CARLYN GRACE (DC)
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:GRACE
Last Name:VAN BLARICUM
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 1:902 CONWAY DR APT 204
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3838
Mailing Address - Country:US
Mailing Address - Phone:913-568-1556
Mailing Address - Fax:
Practice Address - Street 1:219 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5649
Practice Address - Country:US
Practice Address - Phone:757-259-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor