Provider Demographics
NPI:1881898724
Name:CODY A CARTER DC
Entity type:Organization
Organization Name:CODY A CARTER DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-561-4350
Mailing Address - Street 1:921 SHILOH RD
Mailing Address - Street 2:SUITE C110
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1431
Mailing Address - Country:US
Mailing Address - Phone:903-561-4350
Mailing Address - Fax:903-561-4349
Practice Address - Street 1:921 SHILOH RD
Practice Address - Street 2:SUITE C110
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1431
Practice Address - Country:US
Practice Address - Phone:903-561-4350
Practice Address - Fax:903-561-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00328ZMedicare ID - Type Unspecified
TXV06278Medicare UPIN