Provider Demographics
NPI:1760730378
Name:CARLSON FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CARLSON FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:REED
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-772-7890
Mailing Address - Street 1:335 CRESTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4731
Mailing Address - Country:US
Mailing Address - Phone:303-772-7890
Mailing Address - Fax:
Practice Address - Street 1:900 COFFMAN ST STE D
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4588
Practice Address - Country:US
Practice Address - Phone:303-772-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty