Carl John Abendroth III, DC
Individual provider Active NPI Chiropractor · Stuart, FL
NPI 1649339698 · NPPES record last updated Jun 13, 2008
Key facts
- NPI
- 1649339698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH7777 (FL)
- Practice address
- 2100 SE Ocean Blvd
Suite 101
Stuart, FL 34996-3332 - Phone
- (772) 223-7337
- Fax
- (772) 223-0305
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050705000414 | FL | Practitioner - Chiropractic |
6608812318 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH7777 | FL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rapid Response Medical LLC | Current | Accepting new patients | |
| Kenneth Gilmore DC PA | Chiropractor | Current |
Accepting new patients |
| Florida Spine and Disc Center, Inc. | Chiropractor | Past |
Accepting new patients |
| Schramm Physical Therapy, Inc | Past | Accepting new patients |
Locations
800 Virginia Ave
Ste 45
Fort Pierce, FL 34982
Phone (772) 266-7846
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH7777 | FL | Yes |
Addresses
Primary practice location
2100 SE Ocean Blvd
Suite 101
Stuart, FL 34996-3332
Mailing address
2100 SE Ocean Blvd
Suite 101
Stuart, FL 34996-3332
Phone (772) 223-7337
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 650951021 | Other | FL | TAX ID |
| CH7777 | Other | FL | STATE LICENSE |
| 55897 | Other | FL | BCBS PROVIDER ID |
Other providers in Stuart, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.