MEDICARE: DR. BENJAMIN JOHN CARLSON 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	007344	IA

General Provider Information

NPI Number	:	1780999151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN JOHN CARLSON D.C.

Provider Business Mailing Address
First Line	:	301 S. MAIN ST.
Second Line	:
City	:	NEW SHARON
State	:	IA
Zip	:	50207-0424
Country	:	US
Telephone Number	:	641-637-2270
Fax Number	:	641-637-8048

Provider Business Practice Location Address
First Line	:	301 S. MAIN ST.
Second Line	:
City	:	NEW SHARON
State	:	IA
Zip	:	50207-0424
Country	:	US
Telephone Number	:	641-637-2270
Fax Number	:	641-637-8048

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	11/03/2020

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