Provider Demographics
NPI:1124154687
Name:CARR, JOSEPH B (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:CARR
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 1:402 PENN AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55405
Mailing Address - Country:US
Mailing Address - Phone:612-377-3248
Mailing Address - Fax:
Practice Address - Street 1:402 PENN AVE SOUTH
Practice Address - Street 2:
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55405
Practice Address - Country:US
Practice Address - Phone:612-377-3248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54G30CAOtherBCBS OF MN