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General NPI Number Information
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NPI Number | 1679774699
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Entity Type | Organization
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Legal Business Name | ANDREW G. CARR, D.C. P.C.
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 234 E FERGUSON AVE
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City | WOOD RIVER
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State | IL
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Zip | 62095-2002
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Country | US
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Telephone | 618-254-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 234 E FERGUSON AVE
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City | WOOD RIVER
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State | IL
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Zip | 62095-2002
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Country | US
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Telephone | 618-254-1100
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Fax | 618-254-1100
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ANDREW G. CARR
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Credential | D.C.
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Telephone | 618-254-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38010941
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License Number State | IL
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