Provider Demographics
NPI:1356351779
Name:ANTHONY, CARL JOHN (D C)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:JOHN
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:D C
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 5831
Mailing Address - Street 2:509 WHEELER RD
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0170
Mailing Address - Country:US
Mailing Address - Phone:631-348-5175
Mailing Address - Fax:631-348-5176
Practice Address - Street 1:509 WHEELER RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4347
Practice Address - Country:US
Practice Address - Phone:631-348-5175
Practice Address - Fax:631-348-5176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor