MEDICARE: DR. ELIZABETH A CARPENTER 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	DC5765L	PA
2	111N00000X	Chiropractor	33734	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800338	OTHER	PA	BLUE CROSS PERSONAL CHOIC

General Provider Information

NPI Number	:	1972574804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH A CARPENTER D.C.

Provider Business Mailing Address
First Line	:	18017 CHATSWORTH ST # 675
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5608
Country	:	US
Telephone Number	:	215-262-7916
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 LANKERSHIM BLVD STE 104
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602
Country	:	US
Telephone Number	:	215-262-7916
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	06/26/2019

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