=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649339698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL JOHN ABENDROTH III DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 SE OCEAN BLVD SUITE 101
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34996-3332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-223-7337
-----------------------------------------------------
Fax | 772-223-0305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 SE OCEAN BLVD SUITE 101
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34996-3332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-223-7337
-----------------------------------------------------
Fax | 772-223-0305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH7777
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------