Healthcare Provider Details

I. General information

NPI: 1225115587
Provider Name (Legal Business Name): EDWARD E. CARR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2978 SOUTHMOOR DR
FORT COLLINS CO
80525-2216
US

IV. Provider business mailing address

2978 SOUTHMOOR DR
FORT COLLINS CO
80525-2216
US

V. Phone/Fax

Practice location:
  • Phone: 970-690-9084
  • Fax: 970-204-1980
Mailing address:
  • Phone: 970-690-9084
  • Fax: 970-204-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1457
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1457
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: