MEDICARE: GRADY L 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	CH2947	FL

General Provider Information

NPI Number	:	1245211267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRADY L CARTER DC

Provider Business Mailing Address
First Line	:	4211 N PEARL ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-6411
Country	:	US
Telephone Number	:	904-358-8692
Fax Number	:	904-354-7161

Provider Business Practice Location Address
First Line	:	4211 N PEARL ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-6411
Country	:	US
Telephone Number	:	904-358-8692
Fax Number	:	904-354-7161

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	02/04/2008

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Directions to “ GRADY L CARTER DC” Practice Location

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