Provider Demographics
NPI:1275787814
Name:CARLS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CARLS CHIROPRACTIC, LLC
Other - Org Name:SPRING LAKE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER / PRIMARY CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-806-0572
Mailing Address - Street 1:18210 MOHAWK DR UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9488
Mailing Address - Country:US
Mailing Address - Phone:269-806-0572
Mailing Address - Fax:
Practice Address - Street 1:301 W SAVIDGE ST STE B
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-3103
Practice Address - Country:US
Practice Address - Phone:269-806-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty