MEDICARE: DR. CRAIG D. CARTER D.C.

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	2586	GA
2	111NR0400X	Rehabilitation Chiropractor	2586	GA

General Provider Information

NPI Number	:	1720113665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG D. CARTER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 354
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30031-0354
Country	:	US
Telephone Number	:	404-499-0005
Fax Number	:	404-499-0006

Provider Business Practice Location Address
First Line	:	118 N AVONDALE RD
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1325
Country	:	US
Telephone Number	:	404-499-0005
Fax Number	:	404-499-0006

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	04/06/2015

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