Provider Demographics
NPI:1821244237
Name:CHERI CARLSON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CHERI CARLSON CHIROPRACTIC LLC
Other - Org Name:SYNERGY CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-257-8266
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHERI CARLSON CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU68716Medicare UPIN