MEDICARE: CARPENTER CHIROPRACTIC CENTER, PLLC

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	4854	KY

General Provider Information

NPI Number	:	1891988382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARPENTER CHIROPRACTIC CENTER, PLLC

Provider Business Mailing Address
First Line	:	161 ST. MATTHEWS AVE
Second Line	:	SUITE 13
City	:	LOUISVILLE
State	:	KY
Zip	:	40207
Country	:	US
Telephone Number	:	502-454-3500
Fax Number	:	502-454-3015

Provider Business Practice Location Address
First Line	:	161 SAINT MATTHEWS AVE
Second Line	:	SUITE 13
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3145
Country	:	US
Telephone Number	:	502-454-3500
Fax Number	:	502-454-3015

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	KIMBERLY BETH CARPENTER
Credential	:	DC
Telephone Number	:	502-454-3500

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	09/12/2011

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