1093874968 NPI number — CARTER CHIROPRACTIC AND WELLNESS L L C

Table of content: (NPI 1093874968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093874968 NPI number — CARTER CHIROPRACTIC AND WELLNESS L L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTER CHIROPRACTIC AND WELLNESS L L C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BABY BOOMER CHIROPRACTIC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093874968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 PIPER BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34110-1387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-784-8895
Provider Business Mailing Address Fax Number:
888-784-8895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 PIPER BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34110-1387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-784-8895
Provider Business Practice Location Address Fax Number:
888-784-8895
Provider Enumeration Date:
12/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
239-784-8895

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH9228 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 382134000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103699700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com