Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 18753 | CA |
N | 111NI0013X | Independent Medical Examiner | 18753 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 18753 | CA |
NPI | 1619141280 |
---|---|
Provider Name | Dr. Perry Jay Carpenter |
First Address | Orangevale, CA 95662 |
Second Address | Fair Oaks, CA 95628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 15/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0187530 | (02) | CA |