Provider Demographics
NPI:1760546584
Name:CARLSON CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CARLSON CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-781-6300
Mailing Address - Street 1:2318 E 32ND STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0923
Mailing Address - Country:US
Mailing Address - Phone:417-781-6300
Mailing Address - Fax:417-781-6309
Practice Address - Street 1:2318 E 32ND STREET
Practice Address - Street 2:SUITE B
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0923
Practice Address - Country:US
Practice Address - Phone:417-781-6300
Practice Address - Fax:417-781-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODA6211Medicare PIN
MO000013971Medicare PIN