Provider Demographics
NPI:1568468049
Name:CARSON, LYNDON K (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:K
Last Name:CARSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:LYNDEN
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:7517 S MCCLINTOCK DR
Mailing Address - Street 2:STE 104
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5011
Mailing Address - Country:US
Mailing Address - Phone:480-831-6050
Mailing Address - Fax:480-940-3844
Practice Address - Street 1:7517 S MCCLINTOCK DR
Practice Address - Street 2:STE 104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5011
Practice Address - Country:US
Practice Address - Phone:480-831-6050
Practice Address - Fax:480-940-3844
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0240720OtherBLUE CROSS BLUE SHIELD
AZT76877Medicare UPIN
AZAZ0240720OtherBLUE CROSS BLUE SHIELD