Provider Demographics
NPI:1013149566
Name:CARTER, JOSEPH BEAU
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BEAU
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4193 S OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2067
Mailing Address - Country:US
Mailing Address - Phone:303-396-9183
Mailing Address - Fax:888-771-9183
Practice Address - Street 1:4193 S OLIVE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2067
Practice Address - Country:US
Practice Address - Phone:303-396-9183
Practice Address - Fax:888-771-9183
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter