Provider Demographics
NPI:1790713774
Name:CARLSON, CHERYL J (DC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:J
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2177 TROOP DR
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4563
Mailing Address - Country:US
Mailing Address - Phone:320-257-8266
Mailing Address - Fax:320-257-7407
Practice Address - Street 1:2177 TROOP DR
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4563
Practice Address - Country:US
Practice Address - Phone:320-257-8266
Practice Address - Fax:320-257-7407
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5711799700OtherMEDICAL ASSISTANCE
MN232015OtherACN
MN05D21CAOtherBLUE CROSS BLUE SHIELD
MN640OtherHSM
MNU68716Medicare UPIN
MN640OtherHSM