Provider Demographics
NPI:1417026386
Name:CARPENTIER, CHARLES HERBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HERBERT
Last Name:CARPENTIER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 CONSTITUTION BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1613
Mailing Address - Country:US
Mailing Address - Phone:269-323-9473
Mailing Address - Fax:269-323-9475
Practice Address - Street 1:6051 CONSTITUTION BLVD STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1613
Practice Address - Country:US
Practice Address - Phone:269-323-9473
Practice Address - Fax:269-323-9475
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C95056OtherBLUE CROSS MI
MI0C95056OtherBLUE CROSS MI
MIU82318Medicare UPIN