Provider Demographics
NPI:1053439695
Name:URBAN, CARROL E (DC)
Entity type:Individual
Prefix:DR
First Name:CARROL
Middle Name:E
Last Name:URBAN
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 1:8827 HOUGH RD
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-9664
Mailing Address - Country:US
Mailing Address - Phone:810-798-8603
Mailing Address - Fax:
Practice Address - Street 1:6201 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1610
Practice Address - Country:US
Practice Address - Phone:586-264-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E018570OtherBCBSM
MI950E018570OtherBCBSM
MIP26910002Medicare ID - Type Unspecified