Provider Demographics
NPI:1518618743
Name:CARTER CHIROPRACTIC OFFICE LTD
Entity Type:Organization
Organization Name:CARTER CHIROPRACTIC OFFICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-691-0486
Mailing Address - Street 1:1605 W CANDLETREE DR STE 111
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1597
Mailing Address - Country:US
Mailing Address - Phone:309-691-0486
Mailing Address - Fax:309-683-1113
Practice Address - Street 1:1605 W CANDLETREE DR STE 111
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1597
Practice Address - Country:US
Practice Address - Phone:309-691-0486
Practice Address - Fax:309-683-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty