Provider Demographics
NPI:1699210302
Name:CARTER, JOSEPH JOHN (L AC)
Entity Type:Individual
Prefix:PROF
First Name:JOSEPH
Middle Name:JOHN
Last Name:CARTER
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GOLDEN HINDE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3818
Mailing Address - Country:US
Mailing Address - Phone:510-524-4151
Mailing Address - Fax:
Practice Address - Street 1:700 E ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2762
Practice Address - Country:US
Practice Address - Phone:510-524-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3243171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist