Provider Demographics
NPI:1801106240
Name:CARMICHAEL, JUSTIN S (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:S
Last Name:CARMICHAEL
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 1:104 GRAPEVINE HWY
Mailing Address - Street 2:#400
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054
Mailing Address - Country:US
Mailing Address - Phone:817-485-2400
Mailing Address - Fax:817-485-2475
Practice Address - Street 1:104 GRAPEVINE HWY
Practice Address - Street 2:#400
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054
Practice Address - Country:US
Practice Address - Phone:817-485-2400
Practice Address - Fax:817-485-2475
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002415111N00000X
TX12027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX413462YTFGMedicare PIN