Healthcare Provider Details

I. General information

NPI: 1154588192
Provider Name (Legal Business Name): CARR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E BROADWAY STREET
FORT RECOVERY OH
45846-0672
US

IV. Provider business mailing address

PO BOX 672
FORT RECOVERY OH
45846-0672
US

V. Phone/Fax

Practice location:
  • Phone: 419-375-1808
  • Fax: 419-375-1709
Mailing address:
  • Phone: 419-375-1808
  • Fax: 419-375-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3511
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL JOSEPH CARR
Title or Position: OWNER
Credential: D.C.
Phone: 419-375-1808