Individual
DR. BRUCE CHARLES CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
9 3RD ST NE, AITKIN, MN 56431-1421
(218) 927-2541
Mailing address
9 3RD ST NE, AITKIN, MN 56431-1421
(218) 927-2541
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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