Provider Demographics
NPI:1497773253
Name:CARLSON, JOHN DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
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 1:6905 W GATE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5141
Mailing Address - Country:US
Mailing Address - Phone:512-447-9093
Mailing Address - Fax:512-447-3366
Practice Address - Street 1:6905 W GATE BLVD STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5141
Practice Address - Country:US
Practice Address - Phone:512-447-9093
Practice Address - Fax:512-447-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U37EOtherEMC PAYOR NUMBER
TX00U37EOtherEMC PAYOR NUMBER
TXTXB117904Medicare PIN
TX87Y891Medicare ID - Type Unspecified