Provider Demographics
NPI:1457678393
Name:CARPENTER, ABRAHAM MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:MICHAEL
Last Name:CARPENTER
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 1:15462 ELK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5350
Mailing Address - Country:US
Mailing Address - Phone:314-359-5038
Mailing Address - Fax:
Practice Address - Street 1:2315 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8659
Practice Address - Country:US
Practice Address - Phone:636-978-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010013340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor