MEDICARE: CARLSON CHIROPRACTIC HEALTH AND HEALING INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	MN4108	MN

General Provider Information

NPI Number	:	1083747711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLSON CHIROPRACTIC HEALTH AND HEALING INC.

Provider Business Mailing Address
First Line	:	4960 HIGHWAY 12
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-8729
Country	:	US
Telephone Number	:	763-479-3388
Fax Number	:	763-479-3388

Provider Business Practice Location Address
First Line	:	4960 HIGHWAY 12
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-8729
Country	:	US
Telephone Number	:	763-479-3388
Fax Number	:	763-479-3388

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. BENJAMIN CARLSON
Credential	:	D.C.
Telephone Number	:	763-479-3388

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/25/2015

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