Provider Demographics
NPI:1184775900
Name:MYNATT, CAROL A (DC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:MYNATT
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 1:2105 ELECTRIC RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2317
Mailing Address - Country:US
Mailing Address - Phone:540-491-3220
Mailing Address - Fax:
Practice Address - Street 1:2105 ELECTRIC RD STE 102
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2317
Practice Address - Country:US
Practice Address - Phone:540-491-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557066111N00000X
NC3839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor