MEDICARE: ANDREW G. CARR, D.C. P.C.

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	38010941	IL

General Provider Information

NPI Number	:	1679774699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW G. CARR, D.C. P.C.

Provider Business Mailing Address
First Line	:	234 E FERGUSON AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2002
Country	:	US
Telephone Number	:	618-254-1100
Fax Number	:	618-254-1100

Provider Business Practice Location Address
First Line	:	234 E FERGUSON AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2002
Country	:	US
Telephone Number	:	618-254-1100
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ANDREW G. CARR
Credential	:	D.C.
Telephone Number	:	618-254-1100

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	10/11/2012

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