Provider Demographics
NPI:1700914967
Name:CARLSON, DAVID MICHAEL (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N HANCOCK ST.
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-632-1589
Mailing Address - Fax:719-632-1655
Practice Address - Street 1:3030 N HANCOCK AVE
Practice Address - Street 2:SUITE D
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5761
Practice Address - Country:US
Practice Address - Phone:719-632-1589
Practice Address - Fax:719-632-1655
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC475618Medicare PIN