Provider Demographics
NPI:1609008150
Name:CARLSON, JULIA JOHANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:JOHANNA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 GOLF RD
Mailing Address - Street 2:STE 103
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7073
Mailing Address - Country:US
Mailing Address - Phone:715-579-3782
Mailing Address - Fax:
Practice Address - Street 1:2522 GOLF RD
Practice Address - Street 2:SUITE 1
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6032
Practice Address - Country:US
Practice Address - Phone:715-832-2019
Practice Address - Fax:715-832-3027
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4520-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor