Provider Demographics
NPI:1700829413
Name:CARTER, CASEY (DC, LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:DC, LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRUSH CREEK RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-2085
Mailing Address - Country:US
Mailing Address - Phone:707-538-3000
Mailing Address - Fax:707-303-7199
Practice Address - Street 1:100 BRUSH CREEK RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-2085
Practice Address - Country:US
Practice Address - Phone:707-538-3000
Practice Address - Fax:707-303-7199
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27212111N00000X
CAAC6602171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor