Provider Demographics
NPI:1912321662
Name:CARLSON, JUSTIN (RDCS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 S MINNESOTA AVE
Mailing Address - Street 2:#203
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2592
Mailing Address - Country:US
Mailing Address - Phone:605-274-2525
Mailing Address - Fax:605-274-0620
Practice Address - Street 1:6709 S MINNESOTA AVE
Practice Address - Street 2:#203
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2592
Practice Address - Country:US
Practice Address - Phone:605-274-2525
Practice Address - Fax:605-274-0620
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
119296OtherARDMS