Provider Demographics
NPI:1396733598
Name:CARPENTER, JEFFREY D (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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 1:112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-1709
Mailing Address - Country:US
Mailing Address - Phone:636-586-4226
Mailing Address - Fax:636-586-3791
Practice Address - Street 1:112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1709
Practice Address - Country:US
Practice Address - Phone:636-586-4226
Practice Address - Fax:636-586-3791
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245166OtherGHP
MO199493OtherANTHEM
MO709890OtherHEALTHLINK
MO245166OtherGHP