MEDICARE: DR. CARL L. PEARSON JR. D.C.

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	CH11561	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	IM259Z	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH11561	OTHER	FL	FLORIDA CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1538321179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL L. PEARSON JR. D.C.

Provider Business Mailing Address
First Line	:	2122 W NINE MILE RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-9464
Country	:	US
Telephone Number	:	850-473-5555
Fax Number	:	850-473-5505

Provider Business Practice Location Address
First Line	:	2122 W NINE MILE RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-9464
Country	:	US
Telephone Number	:	850-473-5555
Fax Number	:	850-473-5505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	03/11/2021

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Directions to “ DR. CARL L. PEARSON JR. D.C.” Practice Location

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