Provider Demographics
NPI:1720268873
Name:CARBONE CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:CARBONE CHIROPRACTIC CENTER, INC.
Other - Org Name:ALOHA FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-934-5757
Mailing Address - Street 1:4850 S BRADLEY RD
Mailing Address - Street 2:#A-1
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5071
Mailing Address - Country:US
Mailing Address - Phone:805-934-5757
Mailing Address - Fax:805-934-5758
Practice Address - Street 1:4850 S BRADLEY RD
Practice Address - Street 2:#A-1
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5071
Practice Address - Country:US
Practice Address - Phone:805-934-5757
Practice Address - Fax:805-934-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19401Medicare PIN