Provider Demographics
NPI:1821130899
Name:CARPENTER, JEFFERY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:A
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 1:5900 CENTENNIAL CIR STE 180
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4249
Mailing Address - Country:US
Mailing Address - Phone:859-620-1325
Mailing Address - Fax:859-282-2027
Practice Address - Street 1:5900 CENTENNIAL CIR STE 180
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4249
Practice Address - Country:US
Practice Address - Phone:859-620-1325
Practice Address - Fax:859-282-2027
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3295111N00000X
KY261113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU92708Medicare UPIN
OH4096191Medicare ID - Type Unspecified