=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144493511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA J. CARRICK D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2008
-----------------------------------------------------
Last Update Date | 11/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3355 KESWICK RD THE CARRIAGE HOUSE, SUITE 200
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21211-2648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-235-9355
-----------------------------------------------------
Fax | 410-235-9357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3355 KESWICK RD THE CARRIAGE HOUSE, SUITE 200
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21211-2648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-235-9355
-----------------------------------------------------
Fax | 410-235-9357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | F1-0000686
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 03592
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556705
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------