Provider Demographics
NPI:1083747711
Name:CARLSON CHIROPRACTIC HEALTH AND HEALING INC.
Entity Type:Organization
Organization Name:CARLSON CHIROPRACTIC HEALTH AND HEALING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-479-3388
Mailing Address - Street 1:4960 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:MAPLE PLAIN
Mailing Address - State:MN
Mailing Address - Zip Code:55359-8729
Mailing Address - Country:US
Mailing Address - Phone:763-479-3388
Mailing Address - Fax:763-479-3388
Practice Address - Street 1:4960 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:MAPLE PLAIN
Practice Address - State:MN
Practice Address - Zip Code:55359-8729
Practice Address - Country:US
Practice Address - Phone:763-479-3388
Practice Address - Fax:763-479-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN4108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty