Provider Demographics
NPI:1629229711
Name:CARLSON, LUCAS HOWARD (DC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:HOWARD
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 1:2411 2ND ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1500
Mailing Address - Country:US
Mailing Address - Phone:319-337-2335
Mailing Address - Fax:319-337-2353
Practice Address - Street 1:2411 2ND ST
Practice Address - Street 2:STE. 1
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1500
Practice Address - Country:US
Practice Address - Phone:319-337-2335
Practice Address - Fax:319-337-2353
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1629229711Medicaid
IA1629229711OtherBCBS