Provider Demographics
NPI:1902004252
Name:CARSON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CARSON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS/VP
Authorized Official - Prefix:DR
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-831-6050
Mailing Address - Street 1:7517 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5011
Mailing Address - Country:US
Mailing Address - Phone:480-831-6050
Mailing Address - Fax:480-756-5707
Practice Address - Street 1:7517 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5011
Practice Address - Country:US
Practice Address - Phone:480-831-6050
Practice Address - Fax:480-940-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4492111N00000X
AZ4493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBPPMedicare PIN