Provider Demographics
NPI:1982797585
Name:DECARLO, ANTHONY A (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:DECARLO
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 1:164 LONDON SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741
Mailing Address - Country:US
Mailing Address - Phone:606-864-3595
Mailing Address - Fax:606-878-5499
Practice Address - Street 1:164 LONDON SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741
Practice Address - Country:US
Practice Address - Phone:606-864-3595
Practice Address - Fax:606-878-5499
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000041618OtherANTHEM BC/BS
KY350040041OtherMEDICARE RAILROAD
KY85036523Medicaid
KY350040041OtherMEDICARE RAILROAD
KY1790901Medicare ID - Type Unspecified