Healthcare Provider Details

I. General information

NPI: 1316105034
Provider Name (Legal Business Name): CARPENTER'S HEALTH CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 STERLINGTON HWY
FARMERVILLE LA
71241-3122
US

IV. Provider business mailing address

509 STERLINGTON HWY
FARMERVILLE LA
71241-3122
US

V. Phone/Fax

Practice location:
  • Phone: 318-368-9049
  • Fax: 318-368-9051
Mailing address:
  • Phone: 318-368-9049
  • Fax: 318-368-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1183
License Number StateLA

VIII. Authorized Official

Name: DR. LYNDON BAIN CARPENTER
Title or Position: OWNER
Credential: D.C.
Phone: 318-368-9049