Provider Demographics
NPI:1093996373
Name:CARTER, BRANDON REX (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:REX
Last Name:CARTER
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 1:1704 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-8011
Mailing Address - Country:US
Mailing Address - Phone:435-709-1447
Mailing Address - Fax:801-224-3235
Practice Address - Street 1:1704 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8011
Practice Address - Country:US
Practice Address - Phone:435-709-1447
Practice Address - Fax:801-224-3235
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30661111N00000X
UT6961493-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT04906Medicare UPIN