Healthcare Provider Details

I. General information

NPI: 1003487232
Provider Name (Legal Business Name): CARESSA GULLIKSON, DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E HERSEY ST STE 2A
ASHLAND OR
97520-1363
US

IV. Provider business mailing address

108 E HERSEY ST STE 2A
ASHLAND OR
97520-1363
US

V. Phone/Fax

Practice location:
  • Phone: 541-482-4823
  • Fax:
Mailing address:
  • Phone: 541-482-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARESSA A GULLIKSON
Title or Position: OWNER
Credential: DC
Phone: 541-941-4959