Provider Demographics
NPI:1699868182
Name:DI CARLO, JOSEPH ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:DI CARLO
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 1:56 PORTWEST CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5985
Mailing Address - Country:US
Mailing Address - Phone:636-949-5700
Mailing Address - Fax:636-916-3735
Practice Address - Street 1:56 PORTWEST CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5985
Practice Address - Country:US
Practice Address - Phone:636-949-5700
Practice Address - Fax:636-916-3735
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1768965OtherFEDERAL TAX ID #
MO5662OtherBLUE CROSS/ BLUE SHIELD
MO5662OtherBLUE CROSS/ BLUE SHIELD
MO43-1768965OtherFEDERAL TAX ID #