Provider Demographics
NPI:1023224631
Name:CARRILLO, ALCIDES HECTOR (DC)
Entity type:Individual
Prefix:DR
First Name:ALCIDES
Middle Name:HECTOR
Last Name:CARRILLO
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 1:317 E DIAMOND AVE
Mailing Address - Street 2:202
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3093
Mailing Address - Country:US
Mailing Address - Phone:301-977-8595
Mailing Address - Fax:901-977-8596
Practice Address - Street 1:317 E DIAMOND AVE
Practice Address - Street 2:202
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3093
Practice Address - Country:US
Practice Address - Phone:301-977-8595
Practice Address - Fax:901-977-8596
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2005111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11378431Medicare UPIN