MEDICARE: DIA LAURENCIA CARTER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	13047	FL

General Provider Information

NPI Number	:	1023648656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIA LAURENCIA CARTER DC

Provider Business Mailing Address
First Line	:	10646 PONTOFINO CIR
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-7058
Country	:	US
Telephone Number	:	727-366-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 S ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3308
Country	:	US
Telephone Number	:	813-254-4377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/23/2020

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