Provider Demographics
NPI:1821026717
Name:CARSON CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:CARSON CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-551-1003
Mailing Address - Street 1:4541 STATE ROUTE 71
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7416
Mailing Address - Country:US
Mailing Address - Phone:630-551-1003
Mailing Address - Fax:630-551-4914
Practice Address - Street 1:4541 STATE ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7416
Practice Address - Country:US
Practice Address - Phone:630-551-1003
Practice Address - Fax:630-551-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL047-32019OtherBC/BS PROVIDER#
IL214-1847OtherFIRSTHEALTH PROVIDER#
IL208293Medicare ID - Type Unspecified