Provider Demographics
NPI:1780999151
Name:CARLSON, BENJAMIN JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHN
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 1:301 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:NEW SHARON
Mailing Address - State:IA
Mailing Address - Zip Code:50207-0424
Mailing Address - Country:US
Mailing Address - Phone:641-637-2270
Mailing Address - Fax:641-637-8048
Practice Address - Street 1:301 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:NEW SHARON
Practice Address - State:IA
Practice Address - Zip Code:50207-0424
Practice Address - Country:US
Practice Address - Phone:641-637-2270
Practice Address - Fax:641-637-8048
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor