Provider Demographics
NPI:1801437694
Name:CARLSON, MARK (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
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 1:2377 CUMBERLAND SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3251
Mailing Address - Country:US
Mailing Address - Phone:563-359-9541
Mailing Address - Fax:563-344-3914
Practice Address - Street 1:2377 CUMBERLAND SQUARE DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3251
Practice Address - Country:US
Practice Address - Phone:563-359-9541
Practice Address - Fax:563-344-3914
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor