Healthcare Provider Details

I. General information

NPI: 1003848771
Provider Name (Legal Business Name): CARROLL CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11945 CONQUEST ST
BIRCH RUN MI
48415
US

IV. Provider business mailing address

PO BOX 544
BIRCH RUN MI
48415-0544
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-9293
  • Fax: 989-624-9294
Mailing address:
  • Phone: 989-624-9293
  • Fax: 989-624-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAC009035
License Number StateMI

VIII. Authorized Official

Name: DR. APRIL L CARROLL
Title or Position: OWNER
Credential:
Phone: 989-624-9293