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General NPI Number Information
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NPI Number | 1891988382
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Entity Type | Organization
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Legal Business Name | CARPENTER CHIROPRACTIC CENTER, PLLC
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 161 SAINT MATTHEWS AVE SUITE 13
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City | LOUISVILLE
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State | KY
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Zip | 40207-3145
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Country | US
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Telephone | 502-454-3500
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Fax | 502-454-3015
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Provider Business Mailing Address
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Address Line | 161 ST. MATTHEWS AVE SUITE 13
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City | LOUISVILLE
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State | KY
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Zip | 40207
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Country | US
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Telephone | 502-454-3500
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Fax | 502-454-3015
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | KIMBERLY BETH CARPENTER
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Credential | DC
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Telephone | 502-454-3500
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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 | 4854
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License Number State | KY
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