MEDICARE: DR. MICHAEL SHANE CARTER D.C., M.B.A.

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	CH9227	FL

General Provider Information

NPI Number	:	1790717775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SHANE CARTER D.C., M.B.A.

Provider Business Mailing Address
First Line	:	4705 S CLYDE MORRIS BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4103
Country	:	US
Telephone Number	:	386-763-2628
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 S CLYDE MORRIS BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4103
Country	:	US
Telephone Number	:	386-763-2628
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/16/2015

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