Provider Demographics
NPI:1770697179
Name:CARNAROLI, LYNN M IV (DC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:CARNAROLI
Suffix:IV
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:CONNAUGHTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:85 SACHEM STREET
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-889-5812
Mailing Address - Fax:
Practice Address - Street 1:85 SACHEM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4201
Practice Address - Country:US
Practice Address - Phone:860-889-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT659225OtherUNITED HEALTHCARE OF NE
CT659255OtherACN GROUP
CT050000586CT01OtherANTHEM BC/BS
CT2370484Medicaid
CTP00063165OtherRAILROAD RETIREMENT
CTCT00586OtherLANDMARK HEALTHCARE
CTP11114893OtherMULTIPLAN
CT000810565345OtherPHCS
GU004074233Medicaid
CTNLS067OtherOXFORD HEALTHCARE
GU004074233Medicaid
CT000810565345OtherPHCS