Provider Demographics
NPI:1629492434
Name:RICHARD CARLSON LLC
Entity Type:Organization
Organization Name:RICHARD CARLSON LLC
Other - Org Name:OPTIMAL HEALTH CHIROPRACTIC AND SPORT INJURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:609-442-1124
Mailing Address - Street 1:610 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-4038
Mailing Address - Country:US
Mailing Address - Phone:609-442-1124
Mailing Address - Fax:
Practice Address - Street 1:610 5TH AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-4038
Practice Address - Country:US
Practice Address - Phone:609-442-1124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00708500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1861837353OtherNPI