Provider Demographics
NPI:1063478444
Name:CARPENTER, G. E (DC)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:E
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:E
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:9820 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73141-4208
Mailing Address - Country:US
Mailing Address - Phone:405-769-6767
Mailing Address - Fax:405-769-6775
Practice Address - Street 1:9820 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73141-4208
Practice Address - Country:US
Practice Address - Phone:405-769-6767
Practice Address - Fax:405-769-6775
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
QDCJXMedicare ID - Type Unspecified