Provider Demographics
NPI:1497802334
Name:CARPENTIER, NANCY K (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:K
Last Name:CARPENTIER
Suffix:
Gender:F
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-2107
Mailing Address - Country:US
Mailing Address - Phone:541-573-3406
Mailing Address - Fax:
Practice Address - Street 1:102 W MONROE ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-2107
Practice Address - Country:US
Practice Address - Phone:541-573-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2737111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU21176Medicare UPIN
OR0000QGFQYMedicare ID - Type Unspecified