Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH4279 | FL |
NPI | 1043419740 |
---|---|
Provider Name | Dr. Steven Carrollton |
First Address | Port St Lucie, FL 34952-4300 |
Second Address | Port St Lucie, FL 34952-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 12/07/2007 |