Provider Demographics
NPI:1255478822
Name:CARTER WELLNESS SYSTEMS, PC
Entity Type:Organization
Organization Name:CARTER WELLNESS SYSTEMS, PC
Other - Org Name:FAMILY TREE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-340-4400
Mailing Address - Street 1:12325 N MAY AVE
Mailing Address - Street 2:111A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1962
Mailing Address - Country:US
Mailing Address - Phone:405-340-4400
Mailing Address - Fax:405-340-4480
Practice Address - Street 1:12325 N MAY AVE
Practice Address - Street 2:111A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1962
Practice Address - Country:US
Practice Address - Phone:405-340-4400
Practice Address - Fax:405-340-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK442904074-001OtherBLUE CROSS BLUE SHIELD
OK442904074-001OtherBLUE CROSS BLUE SHIELD