Provider Demographics
NPI:1801622089
Name:CARR, SAMUEL CLEMENT
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CLEMENT
Last Name:CARR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-3519
Mailing Address - Country:US
Mailing Address - Phone:605-256-0336
Mailing Address - Fax:605-256-0760
Practice Address - Street 1:732 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-3519
Practice Address - Country:US
Practice Address - Phone:605-256-0336
Practice Address - Fax:605-256-0760
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor