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General NPI Number Information
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NPI Number | 1619247467
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Entity Type | Organization
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Legal Business Name | CARLSON ACUPUNCTURE AND CHIROPRACTICE CLINIC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 2317 E LINCOLNWAY SUITE
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City | STERLING
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State | IL
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Zip | 61081-3059
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Country | US
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Telephone | 815-622-2863
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 E LINCOLNWAY SUITE
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City | STERLING
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State | IL
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Zip | 61081-3059
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Country | US
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Telephone | 815-622-2863
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Fax |
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Authorized Official
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Title or Position | DR/OWNER
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Name | STEVEN E CARLSON
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Credential | DC
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Telephone | 815-622-2863
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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 | 198.000118
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.006543
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License Number State | IL
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