Provider Demographics
NPI:1841604873
Name:CARTER CHIROPRACTIC AND WELLNESS CENTER , LLC
Entity Type:Organization
Organization Name:CARTER CHIROPRACTIC AND WELLNESS CENTER , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-796-7201
Mailing Address - Street 1:291 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2699
Mailing Address - Country:US
Mailing Address - Phone:352-796-7201
Mailing Address - Fax:352-796-5215
Practice Address - Street 1:291 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2699
Practice Address - Country:US
Practice Address - Phone:352-796-7201
Practice Address - Fax:352-796-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10098111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEB308ZMedicare Oscar/Certification