Healthcare Provider Details

I. General information

NPI: 1295757763
Provider Name (Legal Business Name): MARK THOMAS CARRICK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 STATE ROUTE 173
BLOOMSBURY NJ
08804
US

IV. Provider business mailing address

PO BOX 377
BLOOMSBURY NJ
08804-0377
US

V. Phone/Fax

Practice location:
  • Phone: 908-479-6988
  • Fax: 908-479-6980
Mailing address:
  • Phone: 908-479-6988
  • Fax: 908-479-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00630800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: