Provider Demographics
NPI:1265546717
Name:CARLSON, GUNNAR PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:GUNNAR
Middle Name:PAUL
Last Name:CARLSON
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 1:1000 EAGLE RIDGE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375
Mailing Address - Country:US
Mailing Address - Phone:219-322-3177
Mailing Address - Fax:219-322-3209
Practice Address - Street 1:1000 EAGLE RIDGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-4207
Practice Address - Country:US
Practice Address - Phone:219-322-3177
Practice Address - Fax:219-322-3209
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor