Provider Demographics
NPI:1477616829
Name:CARSON, CAROL ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:CARSON
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 1:205 W. BOUTZ RD.
Mailing Address - Street 2:BUILDING 4 SUITE 2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-523-8604
Mailing Address - Fax:575-526-2471
Practice Address - Street 1:205 W BOUTZ RD
Practice Address - Street 2:BUILDING 4 SUITE 2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3262
Practice Address - Country:US
Practice Address - Phone:575-523-8604
Practice Address - Fax:575-526-2471
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMV08538Medicare UPIN