MEDICARE: JEFFERY SCOTT CARPENTER, D.C., P.L.L.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	2301008269	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942441803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERY SCOTT CARPENTER, D.C., P.L.L.C.

Provider Business Mailing Address
First Line	:	1530 PINE GROVE AVE
Second Line	:	SUITE 2
City	:	PORT HURON
State	:	MI
Zip	:	48060-3370
Country	:	US
Telephone Number	:	810-966-1600
Fax Number	:	810-966-1601

Provider Business Practice Location Address
First Line	:	1530 PINE GROVE AVE
Second Line	:	SUITE 2
City	:	PORT HURON
State	:	MI
Zip	:	48060-3370
Country	:	US
Telephone Number	:	810-966-1600
Fax Number	:	810-966-1601

Authorized Official
Title or Position	:	RECEPTIONIST/BILLING
Name	:	MS. AMANDA NIEMAN
Credential	:
Telephone Number	:	810-966-1600

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	05/06/2009

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