Provider Demographics
NPI:1912070491
Name:CARLSON, DON KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:KENNETH
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 1:900 E PALM VALLEY BLVD
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3288
Mailing Address - Country:US
Mailing Address - Phone:512-246-8444
Mailing Address - Fax:512-246-8447
Practice Address - Street 1:900 E PALM VALLEY BLVD
Practice Address - Street 2:SUITE 1011
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3288
Practice Address - Country:US
Practice Address - Phone:512-246-8444
Practice Address - Fax:512-246-8447
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2382DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12539Medicare UPIN
600710Medicare ID - Type Unspecified