Provider Demographics
NPI:1982791638
Name:CARR, DANIEL J (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:CARR
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 1:1309 BUCKTAIL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3264
Mailing Address - Country:US
Mailing Address - Phone:814-834-1134
Mailing Address - Fax:
Practice Address - Street 1:1309 BUCKTAIL RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3264
Practice Address - Country:US
Practice Address - Phone:814-834-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007787L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA795327OtherHIGHMARK
PAP00073539OtherRAILROAD MEDICARE
PA795327OtherHIGHMARK
PAU95533Medicare UPIN