Provider Demographics
NPI:1265524243
Name:CARTER, MARY E (DC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1804 STOVALL ST
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8780
Mailing Address - Country:US
Mailing Address - Phone:928-763-1185
Mailing Address - Fax:928-768-4754
Practice Address - Street 1:5455 S HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9227
Practice Address - Country:US
Practice Address - Phone:928-768-1122
Practice Address - Fax:928-768-4754
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCKNQ01Medicare ID - Type UnspecifiedMEDICARE NUMBER
AZU06097Medicare UPIN