Provider Demographics
NPI:1376528620
Name:CARLSON, RANDY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ROBERT
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 1:301 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2238
Mailing Address - Country:US
Mailing Address - Phone:218-736-3972
Mailing Address - Fax:218-736-7915
Practice Address - Street 1:301 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2238
Practice Address - Country:US
Practice Address - Phone:218-736-3972
Practice Address - Fax:218-736-7915
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor