Provider Demographics
NPI:1932625092
Name:SMALL, CARL EVERETT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EVERETT
Last Name:SMALL
Suffix:JR
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 1:3723 W CAMP WISDOM RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2509
Mailing Address - Country:US
Mailing Address - Phone:469-224-7246
Mailing Address - Fax:972-685-5939
Practice Address - Street 1:3723 W CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2509
Practice Address - Country:US
Practice Address - Phone:469-224-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-20
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13573111NN1001X, 111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty