Provider Demographics
NPI:1689634628
Name:CARLO, MARK GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name: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 1:13002 SEMINOLE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2125
Mailing Address - Country:US
Mailing Address - Phone:727-585-8888
Mailing Address - Fax:727-674-0022
Practice Address - Street 1:13002 SEMINOLE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2125
Practice Address - Country:US
Practice Address - Phone:727-585-8888
Practice Address - Fax:727-674-0022
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381074700Medicaid
FL381074700Medicaid
FL55159Medicare PIN