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General NPI Number Information
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NPI Number | 1841694833
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Entity Type | Individual
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Provider Name | CARTER BLUE L.AC.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 18200 S CLEAR ACRES DR
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City | OREGON CITY
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State | OR
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Zip | 97045-9280
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Country | US
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Telephone | 503-899-0472
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Fax |
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Provider Business Mailing Address
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Address Line | 120 S ELLIOTT RD
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City | NEWBERG
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State | OR
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Zip | 97132-2183
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Country | US
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Telephone | 503-899-0472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00435
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License Number State | OR
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