Provider Demographics
NPI:1750310157
Name:CARLSTROM, DOUGLAS PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:CARLSTROM
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 1:2160 W 11TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3564
Mailing Address - Country:US
Mailing Address - Phone:541-484-2004
Mailing Address - Fax:541-484-0800
Practice Address - Street 1:2160 W 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3564
Practice Address - Country:US
Practice Address - Phone:541-484-2004
Practice Address - Fax:541-484-0800
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1732111N00000X
OR1732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR152009Medicaid
OR152009Medicaid
ORU31461Medicare UPIN