Provider Demographics
NPI:1174645550
Name:CARTER CHIROPRACTIC P C
Entity type:Organization
Organization Name:CARTER CHIROPRACTIC P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-667-4332
Mailing Address - Street 1:408 1 ST NW
Mailing Address - Street 2:STE A
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3118
Mailing Address - Country:US
Mailing Address - Phone:701-663-2992
Mailing Address - Fax:701-667-4332
Practice Address - Street 1:408 1 ST NW
Practice Address - Street 2:STE A
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3118
Practice Address - Country:US
Practice Address - Phone:701-663-2992
Practice Address - Fax:701-667-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12388Medicaid
ND21888Medicare PIN
ND12388Medicaid
ND83455Medicare UPIN
NDU83445Medicare UPIN