Provider Demographics
NPI:1417990110
Name:CARMAN, BRIAN W (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:CARMAN
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:P.O BOX 387
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657
Mailing Address - Country:US
Mailing Address - Phone:570-574-9249
Mailing Address - Fax:
Practice Address - Street 1:909 WEST 15TH STREET
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201
Practice Address - Country:US
Practice Address - Phone:570-450-9909
Practice Address - Fax:570-450-6681
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006558L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3272473OtherAETNA
PA0015804600006Medicaid
PA816732OtherFIRST PRIORITY HEALTH
PAU61419Medicare UPIN
PA0015804600006Medicaid