Provider Demographics
NPI:1710945274
Name:CARLS, JOHN CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:CARLS
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 1:952 VASSAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001
Mailing Address - Country:US
Mailing Address - Phone:269-344-7946
Mailing Address - Fax:269-344-6196
Practice Address - Street 1:952 VASSAR DRIVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001
Practice Address - Country:US
Practice Address - Phone:269-344-7946
Practice Address - Fax:269-344-6196
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJC002732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950C912750OtherBCBS
950C912750OtherBCBS
0C95030Medicare ID - Type Unspecified