=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649477571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARSON CHIROPRACTIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2007
-----------------------------------------------------
Last Update Date | 11/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1557 AIRPORT RD., STE A
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-7952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-767-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1557 AIRPORT RD., STE A
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-7952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-767-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC E CARSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 501-767-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------