Provider Demographics
NPI:1609983212
Name:CARLSON, DAVID HERBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HERBERT
Last Name:CARLSON
Suffix:
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:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:SLOUGHHOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95683-1212
Mailing Address - Country:US
Mailing Address - Phone:916-354-0124
Mailing Address - Fax:916-354-9976
Practice Address - Street 1:7248 MURIETA PKWY
Practice Address - Street 2:B-3
Practice Address - City:SLOUGHHOUSE
Practice Address - State:CA
Practice Address - Zip Code:95683
Practice Address - Country:US
Practice Address - Phone:916-354-0124
Practice Address - Fax:916-354-9976
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02061ZMedicare ID - Type UnspecifiedPROVIDER NUMBER