Provider Demographics
NPI:1104929512
Name:CARSKADDAN, BRIAN P (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:CARSKADDAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 HOOPER AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-255-8335
Mailing Address - Fax:732-255-8261
Practice Address - Street 1:1901 HOOPER AVE
Practice Address - Street 2:STE A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-255-8335
Practice Address - Fax:732-255-8261
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00414800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19796Medicare UPIN
CA681796Medicare ID - Type Unspecified