Provider Demographics
NPI:1518917699
Name:CARPENTER, JEFFERY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:SCOTT
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 1:2100 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2543
Mailing Address - Country:US
Mailing Address - Phone:810-982-2700
Mailing Address - Fax:810-982-5194
Practice Address - Street 1:2100 WATER ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2543
Practice Address - Country:US
Practice Address - Phone:810-982-2700
Practice Address - Fax:810-982-5194
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85797Medicare PIN