MEDICARE: DR. EDWARD E. 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	111NN1001X	Nutrition Chiropractor	1457	CO
2	111N00000X	Chiropractor	1457	CO

General Provider Information

NPI Number	:	1225115587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD E. CARR DC

Provider Business Mailing Address
First Line	:	2978 SOUTHMOOR DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2216
Country	:	US
Telephone Number	:	970-690-9084
Fax Number	:	970-204-1980

Provider Business Practice Location Address
First Line	:	2978 SOUTHMOOR DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2216
Country	:	US
Telephone Number	:	970-690-9084
Fax Number	:	970-204-1980

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/09/2010

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