Healthcare Provider Details

I. General information

NPI: 1639008212
Provider Name (Legal Business Name): MARC ANTHONY CARROLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 WASHINGTON AVE APT C
WILLIAMSTOWN NJ
08094-1890
US

IV. Provider business mailing address

117 WASHINGTON AVE APT C
WILLIAMSTOWN NJ
08094-1890
US

V. Phone/Fax

Practice location:
  • Phone: 856-262-7234
  • Fax:
Mailing address:
  • Phone: 856-262-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00820600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: