MEDICARE: DR. PATRICE ANNE CARROLL 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	X005065	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CO5065-0DC	OTHER	NY	WORKERS COMPENSATION
2	10013911-6554	OTHER	NY	CDPHP
3	X39861	OTHER	NY	BCBS

General Provider Information

NPI Number	:	1942366000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICE ANNE CARROLL DC

Provider Business Mailing Address
First Line	:	106 WEST AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-6004
Country	:	US
Telephone Number	:	518-587-0057
Fax Number	:	518-584-3715

Provider Business Practice Location Address
First Line	:	106 WEST AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-6004
Country	:	US
Telephone Number	:	518-587-0057
Fax Number	:	518-584-3715

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

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	04/13/2010

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