Provider Demographics
NPI:1033251871
Name:CARTER, CLARISSA JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:JANE
Last Name:CARTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-1447
Mailing Address - Country:US
Mailing Address - Phone:440-926-8111
Mailing Address - Fax:440-926-1801
Practice Address - Street 1:963 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-1447
Practice Address - Country:US
Practice Address - Phone:440-926-8111
Practice Address - Fax:440-926-1801
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1895111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor