Provider Demographics
NPI:1649281957
Name:CARLOCK, DONALD CLINTON JR (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:CLINTON
Last Name:CARLOCK
Suffix:JR
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 596
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-0596
Mailing Address - Country:US
Mailing Address - Phone:850-944-7011
Mailing Address - Fax:850-944-7165
Practice Address - Street 1:5559 N DAVIS HWY
Practice Address - Street 2:STE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2048
Practice Address - Country:US
Practice Address - Phone:850-944-7011
Practice Address - Fax:850-944-7165
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7173111N00000X
ALAL1691111N00000X
GAGA005631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55449AMedicare ID - Type Unspecified
U54788Medicare UPIN