Provider Demographics
NPI:1881877033
Name:CARLSON CHIROPRACTIC INC
Entity type:Organization
Organization Name:CARLSON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-354-8483
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:SLOUGHHOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95683-1212
Mailing Address - Country:US
Mailing Address - Phone:916-354-8483
Mailing Address - Fax:
Practice Address - Street 1:7248 MURIETA DR.
Practice Address - Street 2:SUITE B-3
Practice Address - City:SLOUGHHOUSE
Practice Address - State:CA
Practice Address - Zip Code:95683
Practice Address - Country:US
Practice Address - Phone:916-354-8483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29029261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0290290Medicare PIN
CAZZZ02061ZMedicare UPIN