MEDICARE: JOSEPH B CARR DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2029	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54G30CA	OTHER	MN	BCBS OF MN

General Provider Information

NPI Number	:	1124154687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH B CARR DC

Provider Business Mailing Address
First Line	:	402 PENN AVE SOUTH
Second Line	:
City	:	MPLS
State	:	MN
Zip	:	55405
Country	:	US
Telephone Number	:	612-377-3248
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 PENN AVE SOUTH
Second Line	:
City	:	MPLS
State	:	MN
Zip	:	55405
Country	:	US
Telephone Number	:	612-377-3248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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