Healthcare Provider Details

I. General information

NPI: 1649339698
Provider Name (Legal Business Name): CARL JOHN ABENDROTH III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE OCEAN BLVD SUITE 101
STUART FL
34996-3332
US

IV. Provider business mailing address

2100 SE OCEAN BLVD SUITE 101
STUART FL
34996-3332
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-7337
  • Fax: 772-223-0305
Mailing address:
  • Phone: 772-223-7337
  • Fax: 772-223-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: