Provider Demographics
NPI:1275567083
Name:CARLSON, MARTIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:CARLSON
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 1:25032 LAS BRISAS RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4077
Mailing Address - Country:US
Mailing Address - Phone:951-304-2242
Mailing Address - Fax:951-304-0403
Practice Address - Street 1:25032 LAS BRISAS RD
Practice Address - Street 2:UNIT A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4077
Practice Address - Country:US
Practice Address - Phone:951-304-2242
Practice Address - Fax:951-304-0403
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0283490Medicare ID - Type Unspecified
CAU95036Medicare UPIN