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General NPI Number Information
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NPI Number | 1871735399
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Entity Type | Organization
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Legal Business Name | CARROLL CHIROPRACTIC & ACUPUNCTURE, P.C.
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 1100 W MAIN ST
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City | EASTLAND
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State | TX
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Zip | 76448-2434
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Country | US
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Telephone | 254-631-0987
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 W MAIN ST
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City | EASTLAND
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State | TX
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Zip | 76448-2434
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY BLAKE CARROLL
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Credential | D.C.
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Telephone | 254-631-0987
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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 | 9670
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License Number State | TX
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