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General NPI Number Information
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NPI Number | 1538879507
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Entity Type | Organization
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Legal Business Name | CHESTER CARLSON D.O. PLLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 5300 AIRPORT BLVD BLDG 7
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City | FORT SMITH
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State | AR
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Zip | 72903-6078
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Country | US
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Telephone | 479-320-8870
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Fax | 479-739-8707
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Provider Business Mailing Address
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Address Line | 1550 PECAN RIDGE DR
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City | ALMA
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State | AR
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Zip | 72921-8494
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Country | US
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Telephone | 501-551-3556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHESTER CARLSON
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Credential | DO
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Telephone | 501-551-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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