Provider Demographics
NPI:1295757763
Name:CARRICK, MARK THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:CARRICK
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:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08804-0377
Mailing Address - Country:US
Mailing Address - Phone:908-479-6988
Mailing Address - Fax:908-479-6980
Practice Address - Street 1:975 STATE ROUTE 173
Practice Address - Street 2:
Practice Address - City:BLOOMSBURY
Practice Address - State:NJ
Practice Address - Zip Code:08804
Practice Address - Country:US
Practice Address - Phone:908-479-6988
Practice Address - Fax:908-479-6980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00630800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099929Medicaid
NJ084840Medicare ID - Type Unspecified
U13037Medicare UPIN