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General NPI Number Information
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NPI Number | 1518618743
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Entity Type | Organization
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Legal Business Name | CARTER CHIROPRACTIC OFFICE LTD
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 1605 W CANDLETREE DR STE 111
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City | PEORIA
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State | IL
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Zip | 61614-1597
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Country | US
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Telephone | 309-691-0486
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Fax | 309-683-1113
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Provider Business Mailing Address
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Address Line | 1605 W CANDLETREE DR STE 111
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City | PEORIA
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State | IL
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Zip | 61614-1597
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Country | US
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Telephone | 309-691-0486
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Fax | 309-683-1113
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JERRY E CARTER
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Credential | DC
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Telephone | 309-691-0486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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