Provider Demographics
NPI:1255306361
Name:CARTER CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:CARTER CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-907-9071
Mailing Address - Street 1:115 COSGROVE LN
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4107
Mailing Address - Country:US
Mailing Address - Phone:864-907-9071
Mailing Address - Fax:
Practice Address - Street 1:2510 WADE HAMPTON BLVD STE B1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1172
Practice Address - Country:US
Practice Address - Phone:864-907-9071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2184, 2202, 2000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH386Medicaid
SCGCH386Medicaid
SC=========OtherBCBS OF SC