Provider Demographics
NPI:1275560526
Name:CARTER, SUSAN MARY (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:CARTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 PIPER BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1387
Mailing Address - Country:US
Mailing Address - Phone:239-784-8895
Mailing Address - Fax:888-784-8895
Practice Address - Street 1:1205 PIPER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1387
Practice Address - Country:US
Practice Address - Phone:239-784-8895
Practice Address - Fax:888-784-8895
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382134000Medicaid
FL382134000Medicaid