Provider Demographics
NPI:1649339698
Name:ABENDROTH, CARL JOHN III (DC)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:JOHN
Last Name:ABENDROTH
Suffix:III
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 1:2100 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3332
Mailing Address - Country:US
Mailing Address - Phone:772-223-7337
Mailing Address - Fax:772-223-0305
Practice Address - Street 1:2100 SE OCEAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3332
Practice Address - Country:US
Practice Address - Phone:772-223-7337
Practice Address - Fax:772-223-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650951021OtherTAX ID
FLCH7777OtherSTATE LICENSE
FL55897OtherBCBS PROVIDER ID
FLCH7777OtherSTATE LICENSE
FL55897Medicare PIN
FLP00263824Medicare PIN