Provider Demographics
NPI:1528157559
Name:WARNER, CARLA IRENE (DC)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:IRENE
Last Name:WARNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 W CACTUS RD
Mailing Address - Street 2:B106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1600
Mailing Address - Country:US
Mailing Address - Phone:623-486-2000
Mailing Address - Fax:
Practice Address - Street 1:6630 W CACTUS RD
Practice Address - Street 2:B106
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1600
Practice Address - Country:US
Practice Address - Phone:623-486-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0938520OtherBCBS ID #
AZZDC4622Medicare PIN
AZAZ0938520OtherBCBS ID #