=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255740106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARTERET CHIROPRACTIC AND FAMILY WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2014
-----------------------------------------------------
Last Update Date | 08/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 WB MCLEAN DR
-----------------------------------------------------
City | CAPE CARTERET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28584-8515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-764-0574
-----------------------------------------------------
Fax | 252-764-0576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 WB MCLEAN DR
-----------------------------------------------------
City | CAPE CARTERET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28584-8515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-764-0574
-----------------------------------------------------
Fax | 252-764-0576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. ANTHONY RAYMOND MONTERO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 252-764-0574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3724
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------