Provider Demographics
NPI:1063580793
Name:CARPENTER, JIMMY LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:LOUIS
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W COLLEGE
Mailing Address - Street 2:BOX 1008
Mailing Address - City:RISING STAR
Mailing Address - State:TX
Mailing Address - Zip Code:76471-1008
Mailing Address - Country:US
Mailing Address - Phone:325-597-1267
Mailing Address - Fax:
Practice Address - Street 1:512 W COLLEGE
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471-1008
Practice Address - Country:US
Practice Address - Phone:325-597-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605765OtherBLUE CROSS NUMBER
TX605752Medicare PIN
TX605765OtherBLUE CROSS NUMBER