Provider Demographics
NPI:1619247467
Name:CARLSON ACUPUNCTURE AND CHIROPRACTICE CLINIC
Entity type:Organization
Organization Name:CARLSON ACUPUNCTURE AND CHIROPRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-622-2863
Mailing Address - Street 1:2317 E LINCOLNWAY
Mailing Address - Street 2:SUITE
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-3059
Mailing Address - Country:US
Mailing Address - Phone:815-622-2863
Mailing Address - Fax:
Practice Address - Street 1:2317 E LINCOLNWAY
Practice Address - Street 2:SUITE
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-3059
Practice Address - Country:US
Practice Address - Phone:815-622-2863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000118111N00000X
IL038.006543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty