Provider Demographics
NPI:1518060193
Name:CARTER, TYSON AVERY (DC)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:AVERY
Last Name:CARTER
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 1:5021 W ST JOSEPH HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917
Mailing Address - Country:US
Mailing Address - Phone:517-394-3353
Mailing Address - Fax:517-394-2723
Practice Address - Street 1:5021 W. ST. JOSEPH HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917
Practice Address - Country:US
Practice Address - Phone:517-394-3353
Practice Address - Fax:517-394-2723
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009024111N00000X
AZ7855111N00000X
WI05440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4755023Medicaid
MI950B310680OtherBCBS
MI950B310680OtherBCBS
MION84420003Medicare ID - Type Unspecified