Provider Demographics
NPI:1528712361
Name:CARLSON, LEAH (DC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 UNITY AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2039
Mailing Address - Country:US
Mailing Address - Phone:763-537-9217
Mailing Address - Fax:
Practice Address - Street 1:4959 OLSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5152
Practice Address - Country:US
Practice Address - Phone:612-874-3980
Practice Address - Fax:763-270-5915
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor