Provider Demographics
NPI:1841462306
Name:CARLSON, STEVEN ERIC
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ERIC
Last Name:CARLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 E LINCOLNWAY STE B
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081
Mailing Address - Country:US
Mailing Address - Phone:815-622-2863
Mailing Address - Fax:815-622-2864
Practice Address - Street 1:2317 E LINCOLNWAY STE B
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081
Practice Address - Country:US
Practice Address - Phone:815-622-2863
Practice Address - Fax:815-622-2864
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006543111N00000X
IL198000118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL576270Medicare PIN