MEDICARE: ILYCIA MARIE CARTER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3959	TN

General Provider Information

NPI Number	:	1437047362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYCIA MARIE CARTER DC

Provider Business Mailing Address
First Line	:	8101 HACKS CROSS RD STE 110
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-4032
Country	:	US
Telephone Number	:	901-221-7173
Fax Number	:	662-934-8774

Provider Business Practice Location Address
First Line	:	3615 S HOUSTON LEVEE RD
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-9192
Country	:	US
Telephone Number	:	901-221-7173
Fax Number	:	901-221-7934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	06/27/2025

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