Provider Demographics
NPI:1558544494
Name:DR. DAVID M. CARLSON DC, PC
Entity Type:Organization
Organization Name:DR. DAVID M. CARLSON DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:719-632-1589
Mailing Address - Street 1:3030 N HANCOCK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5761
Mailing Address - Country:US
Mailing Address - Phone:719-632-1589
Mailing Address - Fax:719-632-1655
Practice Address - Street 1:3030 N HANCOCK AVE
Practice Address - Street 2:SUITE D
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5761
Practice Address - Country:US
Practice Address - Phone:719-632-1589
Practice Address - Fax:719-632-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC475608Medicare PIN