Healthcare Provider Details

I. General information

NPI: 1023224631
Provider Name (Legal Business Name): ALCIDES HECTOR CARRILLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E DIAMOND AVE 202
GAITHERSBURG MD
20877-3093
US

IV. Provider business mailing address

317 E DIAMOND AVE 202
GAITHERSBURG MD
20877-3093
US

V. Phone/Fax

Practice location:
  • Phone: 301-977-8595
  • Fax: 901-977-8596
Mailing address:
  • Phone: 301-977-8595
  • Fax: 901-977-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2005
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: