Individual
DR. CARL ROBERT BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
502 1ST AVE SE, LAMOURE, ND 58458-7109
(701) 883-4276
Mailing address
502 1ST AVE SE, DR C R BLACK, LAMOURE, ND 58458-7109
(701) 883-5973
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
658
SD
111N00000X
Chiropractor
834
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10402
—
ND
05
—
7602370
—
SD
Enumeration date
06/23/2005
Last updated
04/29/2019
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