Provider Demographics
NPI:1265538896
Name:CARNEY, MICHAEL MONROE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MONROE
Last Name:CARNEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 4TH ST
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2414
Mailing Address - Country:US
Mailing Address - Phone:218-285-7428
Mailing Address - Fax:218-285-7429
Practice Address - Street 1:440 4TH ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2414
Practice Address - Country:US
Practice Address - Phone:218-285-7428
Practice Address - Fax:218-285-7429
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN70324CAOtherBLUE CROSS BLUE SHIELD
MN352827800Medicaid
792350124Medicare ID - Type Unspecified
359000801Medicare UPIN