Provider Demographics
NPI:1376085928
Name:CARTER, CARMEN
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 S CONSTANCE AVE
Mailing Address - Street 2:SUITE C-6
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4700
Mailing Address - Country:US
Mailing Address - Phone:773-299-8292
Mailing Address - Fax:866-683-7047
Practice Address - Street 1:9510 S CONSTANCE AVE
Practice Address - Street 2:SUITE C-6
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4700
Practice Address - Country:US
Practice Address - Phone:773-299-8292
Practice Address - Fax:866-683-7047
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program