Provider Demographics
NPI:1811048515
Name:CARRICO, BRIAN D (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:CARRICO
Suffix:
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 1:221 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-540-9699
Mailing Address - Fax:310-540-9486
Practice Address - Street 1:21707 HAWTHORNE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-540-9699
Practice Address - Fax:310-540-9699
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T17818Medicare UPIN
CAWDC14565AMedicare ID - Type Unspecified