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General NPI Number Information
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NPI Number | 1689704330
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Entity Type | Organization
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Legal Business Name | BRIAN C CARROLL DC PC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1484 BROADWAY AVE
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City | HOLBROOK
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State | NY
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Zip | 11741
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Country | US
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Telephone | 631-737-3838
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Fax | 631-737-8467
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Provider Business Mailing Address
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Address Line | PO BOX 167
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City | HOLBROOK
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State | NY
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Zip | 11741
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Country | US
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Telephone | 631-737-3838
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Fax | 631-737-8467
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | BRIAN C CARROLL
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Credential | DC PC
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Telephone | 631-737-3838
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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 | X009401
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License Number State | NY
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