Provider Demographics
NPI:1356763502
Name:CARPENTER, COURTNEY RAE (DC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 UNIVERSITY DR N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1303
Mailing Address - Country:US
Mailing Address - Phone:701-364-9270
Mailing Address - Fax:701-364-9268
Practice Address - Street 1:2601 UNIVERSITY DR N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1303
Practice Address - Country:US
Practice Address - Phone:701-364-9270
Practice Address - Fax:701-364-9268
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1464667Medicaid
ND1471124Medicaid