Provider Demographics
NPI:1922021666
Name:GUZMAN, CARLOS B (DC)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:B
Last Name:GUZMAN
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 1:717 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3103
Mailing Address - Country:US
Mailing Address - Phone:813-234-4444
Mailing Address - Fax:
Practice Address - Street 1:717 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3103
Practice Address - Country:US
Practice Address - Phone:813-234-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380930700Medicaid
55383Medicare ID - Type Unspecified
FL380930700Medicaid