MEDICARE: DR. AVERY CARPENTER 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	111NI0900X	Internist Chiropractor	11329	TX

General Provider Information

NPI Number	:	1760700306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVERY CARPENTER DC

Provider Business Mailing Address
First Line	:	4100 MCEWEN RD
Second Line	:	STE 130
City	:	DALLAS
State	:	TX
Zip	:	75244-5113
Country	:	US
Telephone Number	:	972-836-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 MCEWEN RD
Second Line	:	STE 130
City	:	DALLAS
State	:	TX
Zip	:	75244-5113
Country	:	US
Telephone Number	:	972-836-6090
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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Directions to “ DR. AVERY CARPENTER DC” Practice Location

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