MEDICARE: CARLTON CARE CHIROPRACTIC, INC.

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	CH 8322	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C643-013-71-545-0	OTHER	FL	DRIVER LICENSE

General Provider Information

NPI Number	:	1124401302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLTON CARE CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	6400 MANATEE AVE W STE L103
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-2364
Country	:	US
Telephone Number	:	941-301-8323
Fax Number	:	941-792-2800

Provider Business Practice Location Address
First Line	:	6400 MANATEE AVE W STE L103
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-2364
Country	:	US
Telephone Number	:	941-301-8323
Fax Number	:	941-792-2800

Authorized Official
Title or Position	:	OWNER
Name	:	ALENA MARIA CARLTON
Credential	:	D.C.
Telephone Number	:	941-301-8323

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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