Provider Demographics
NPI:1326495771
Name:CARTER FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CARTER FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-345-5555
Mailing Address - Street 1:235 W 35TH ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-6141
Mailing Address - Country:US
Mailing Address - Phone:563-345-5555
Mailing Address - Fax:
Practice Address - Street 1:235 W 35TH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-6141
Practice Address - Country:US
Practice Address - Phone:563-345-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078508261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center