Provider Demographics
NPI:1538321179
Name:PEARSON, CARL L JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:L
Last Name:PEARSON
Suffix:JR
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 1:2122 W NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-9464
Mailing Address - Country:US
Mailing Address - Phone:850-473-5555
Mailing Address - Fax:850-473-5505
Practice Address - Street 1:2122 W NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9464
Practice Address - Country:US
Practice Address - Phone:850-473-5555
Practice Address - Fax:850-473-5505
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH11561OtherFLORIDA CHIROPRACTIC LICENSE
FLIM259ZOtherMEDICARE PTAN