Provider Demographics
NPI:1558432492
Name:CONFORTI, CARL G (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:CONFORTI
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 1:146 CARLYLE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1807
Mailing Address - Country:US
Mailing Address - Phone:813-818-7499
Mailing Address - Fax:
Practice Address - Street 1:4040 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3205
Practice Address - Country:US
Practice Address - Phone:813-818-7499
Practice Address - Fax:813-818-7239
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2239YMedicare ID - Type Unspecified