Healthcare Provider Details

I. General information

NPI: 1134119092
Provider Name (Legal Business Name): CARL RICHARD DOLLISON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 9TH ST
CAMBRIDGE OH
43725-2854
US

IV. Provider business mailing address

500 S 9TH ST
CAMBRIDGE OH
43725-2854
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-9393
  • Fax: 740-439-9395
Mailing address:
  • Phone: 740-439-9393
  • Fax: 740-439-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1731
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1731
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number1731
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: