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General NPI Number Information
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NPI Number | 1114020716
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Entity Type | Organization
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Legal Business Name | CARSON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 1731 EAST 20TH SUITE B
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-782-6565
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Fax | 417-782-5326
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Provider Business Mailing Address
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Address Line | 1731 EAST 20TH SUITE B
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-782-6565
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Fax | 417-782-5326
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Authorized Official
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Title or Position | OWNER
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Name | RODNEY L CARSON
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Credential | DC
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Telephone | 417-782-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 004806
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License Number State | MO
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