Provider Demographics
NPI:1477569747
Name:CARLSON, BARBARA L (DC)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:L
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 1:842 WASHINGTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2214
Mailing Address - Country:US
Mailing Address - Phone:619-297-1168
Mailing Address - Fax:619-291-3436
Practice Address - Street 1:842 WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2214
Practice Address - Country:US
Practice Address - Phone:619-297-1168
Practice Address - Fax:619-291-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU20434Medicare UPIN