Provider Demographics
NPI:1700854999
Name:CARPENTER, ZANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:ZANDALL
Middle Name:
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 1:1548 OCEAN BREEZE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4600
Mailing Address - Country:US
Mailing Address - Phone:213-910-8828
Mailing Address - Fax:505-323-4952
Practice Address - Street 1:10900 MENAUL BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2453
Practice Address - Country:US
Practice Address - Phone:213-910-8828
Practice Address - Fax:505-323-4952
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-26357111N00000X
NM1653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor