Provider Demographics
NPI:1922204049
Name:CARSON ROBERTSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CARSON ROBERTSON CHIROPRACTIC INC
Other - Org Name:ALPHA CHIROPRACTIC & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-812-1800
Mailing Address - Street 1:PO BOX 12377
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248
Mailing Address - Country:US
Mailing Address - Phone:480-812-1800
Mailing Address - Fax:480-812-1839
Practice Address - Street 1:4955 S ALMA SCHOOL RD STE 10
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248
Practice Address - Country:US
Practice Address - Phone:480-812-1800
Practice Address - Fax:480-812-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0943940OtherBCBS
AZDN7052OtherRR MEDICARE
AZ0943940OtherBCBS
AZ104195Medicare ID - Type UnspecifiedGROUP
AZ=========OtherTAX ID