Provider Demographics
NPI:1942344437
Name:CARLSTROM, DAVID A (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:CARLSTROM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 JEFFERSON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2485
Mailing Address - Country:US
Mailing Address - Phone:541-687-2772
Mailing Address - Fax:877-857-2772
Practice Address - Street 1:1902 JEFFERSON ST STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2485
Practice Address - Country:US
Practice Address - Phone:541-687-2772
Practice Address - Fax:877-857-2772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350005425Medicare UPIN
R0000QGBHMMedicare PIN
OR350005425Medicare UPIN