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Individual
DR. BRUCE CHARLES CARROLL
Active
Individual
DR. BRUCE CHARLES CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1720
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41M15CA
BLUE CROSS PROVIDER PIN
MN
01
—
P00130495
RAILROAD MEDICARE PIN
MN
Enumeration date
02/20/2007
Last updated
07/09/2007
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