Provider Demographics
NPI:1205954641
Name:CARROLL, MAUREEN EILEEN (DC)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:EILEEN
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:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303
Mailing Address - Country:US
Mailing Address - Phone:219-696-4772
Mailing Address - Fax:219-696-4772
Practice Address - Street 1:15206 PARRISH
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-0536
Practice Address - Country:US
Practice Address - Phone:219-696-4772
Practice Address - Fax:219-696-4772
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000629A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor