MEDICARE: CARSON CHIROPRACTIC, L.L.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	038-009980	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	047-32019	OTHER	IL	BC/BS PROVIDER#
2	214-1847	OTHER	IL	FIRSTHEALTH PROVIDER#

General Provider Information

NPI Number	:	1821026717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARSON CHIROPRACTIC, L.L.C.

Provider Business Mailing Address
First Line	:	4541 STATE ROUTE 71
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7416
Country	:	US
Telephone Number	:	630-551-1003
Fax Number	:	630-551-4914

Provider Business Practice Location Address
First Line	:	4541 STATE ROUTE 71
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7416
Country	:	US
Telephone Number	:	630-551-1003
Fax Number	:	630-551-4914

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ERIC EDWARD CARSON
Credential	:	D.C.
Telephone Number	:	630-551-1003

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/29/2011

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Directions to “CARSON CHIROPRACTIC, L.L.C. ” Practice Location

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