MEDICARE: MRS. MARY E. CARTER D.C.

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	04395	AZ

General Provider Information

NPI Number	:	1265524243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY E. CARTER D.C.

Provider Business Mailing Address
First Line	:	1804 STOVALL ST
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8780
Country	:	US
Telephone Number	:	928-763-1185
Fax Number	:	928-768-4754

Provider Business Practice Location Address
First Line	:	5455 S HIGHWAY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9227
Country	:	US
Telephone Number	:	928-768-1122
Fax Number	:	928-768-4754

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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