MEDICARE: CARSON CHIROPRACTIC CENER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1095	NM

General Provider Information

NPI Number	:	1063698371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARSON CHIROPRACTIC CENER INC.

Provider Business Mailing Address
First Line	:	1001 N SOLANO DR
Second Line	:	STE C
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2366
Country	:	US
Telephone Number	:	575-523-8604
Fax Number	:	575-523-8604

Provider Business Practice Location Address
First Line	:	1001 N SOLANO DR
Second Line	:	STE C
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2366
Country	:	US
Telephone Number	:	575-523-8604
Fax Number	:	575-523-8604

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. CAROL A CARSON
Credential	:	DC
Telephone Number	:	575-523-8604

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	01/16/2008

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