Provider Demographics
NPI:1669596698
Name:CARBONE, VIVIAN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:MARIE
Last Name:CARBONE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MUNICIPAL DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1043
Mailing Address - Country:US
Mailing Address - Phone:636-296-1093
Mailing Address - Fax:636-296-5955
Practice Address - Street 1:16 MUNICIPAL DR
Practice Address - Street 2:SUITE E
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1043
Practice Address - Country:US
Practice Address - Phone:636-296-1093
Practice Address - Fax:636-296-5955
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO141218800OtherDEPARTMENT OF LABOR PIN
MO4572OtherBLUE CROSS PIN
MO60338OtherGROUP HEALTH PLAN PIN
MO000001686543OtherGREAT WEST PIN
MO431527505OtherCIGNA PIN
MO175409OtherHEALTHLINK PIN
MOP00173065OtherMEDICARE RR
MO431527505OtherCIGNA PIN
MO60338OtherGROUP HEALTH PLAN PIN