Provider Demographics
NPI:1083863641
Name:CARTER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CARTER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-233-3364
Mailing Address - Street 1:500 MILLS AVE
Mailing Address - Street 2:STE E
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4280
Mailing Address - Country:US
Mailing Address - Phone:864-233-3364
Mailing Address - Fax:864-233-3464
Practice Address - Street 1:500 MILLS AVE
Practice Address - Street 2:STE E
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4280
Practice Address - Country:US
Practice Address - Phone:864-233-3364
Practice Address - Fax:864-233-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9093Medicare PIN