Provider Demographics
NPI:1932105418
Name:CARTER, BRYAN GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:GREGORY
Last Name:CARTER
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 1:7315 S HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6616
Mailing Address - Country:US
Mailing Address - Phone:817-346-0453
Mailing Address - Fax:817-346-0967
Practice Address - Street 1:7315 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6616
Practice Address - Country:US
Practice Address - Phone:817-346-0453
Practice Address - Fax:817-346-0967
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06093375Medicaid
TXTXB141533Medicare PIN
U79052Medicare UPIN