Provider Demographics
NPI:1134119092
Name:DOLLISON, CARL RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:RICHARD
Last Name:DOLLISON
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 1:500 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2854
Mailing Address - Country:US
Mailing Address - Phone:740-439-9393
Mailing Address - Fax:740-439-9395
Practice Address - Street 1:500 S 9TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2854
Practice Address - Country:US
Practice Address - Phone:740-439-9393
Practice Address - Fax:740-439-9395
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1731111N00000X, 111NN0400X, 111NR0200X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0975388Medicaid
OH311410997-00OtherOHIO BWC
OHU49945Medicare UPIN
OH0763211Medicare PIN