Provider Demographics
NPI:1962430140
Name:CARRADINE, DENISE M (DC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:CARRADINE
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 1:8286 SOUTH AVE B
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6415
Mailing Address - Country:US
Mailing Address - Phone:330-758-4446
Mailing Address - Fax:330-758-5703
Practice Address - Street 1:8261 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6254
Practice Address - Country:US
Practice Address - Phone:330-758-4446
Practice Address - Fax:330-758-5703
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0917155Medicaid
OHU42010Medicare UPIN
OH0917155Medicaid