Provider Demographics
NPI:1508186511
Name:CARSON CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CARSON CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:775-883-7200
Mailing Address - Street 1:201 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2970
Mailing Address - Country:US
Mailing Address - Phone:775-883-7200
Mailing Address - Fax:775-883-9724
Practice Address - Street 1:201 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2970
Practice Address - Country:US
Practice Address - Phone:775-883-7200
Practice Address - Fax:775-883-9724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARSON CHIROPRACTIC CENTER LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-02
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67149Medicare UPIN