Provider Demographics
NPI:1265657076
Name:CARLSON, CYNTHIA M (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WEST DUNDEE ROAD
Mailing Address - Street 2:SUITE M 13
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089
Mailing Address - Country:US
Mailing Address - Phone:847-808-9696
Mailing Address - Fax:847-808-9763
Practice Address - Street 1:400 WEST DUNDEE ROAD
Practice Address - Street 2:SUITE M 13
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:847-808-9696
Practice Address - Fax:847-808-9763
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0077691111N00000X
WI2963111N00000X
PADC005347L111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01606934OtherBCBS
379040Medicare ID - Type Unspecified