Carlson Chiropractic Corporation
Organization Active NPI Chiropractor · White Bear Lake, MN
NPI 1982888020 · NPPES record last updated Sep 29, 2008
Key facts
- NPI
- 1982888020
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4394 (MN)
- Legal business name
- CARLSON CHIROPRACTIC CORPORATION
- Practice address
- 4717 Clark Ave
White Bear Lake, MN 55110-3221 - Phone
- (651) 762-8040
- NPI assigned
- Dec 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Dustin Carlson, DC
- Title
- President
- Phone
- (651) 762-8040
Practitioners 8
-
Jessica Burton, DC
-
Dustin Paul Carlson, D.C.
-
Mitchell Wayne Green, D.C.
-
Lorraine Claire Miller, MASSAGE THERAPIST
-
Derek Thomas Ashton, D.C.
-
Travis Patrick Scott, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080331000035 | MN | Part B Supplier - Clinic/Group Practice | 0749366821 |
Receives reassigned benefits from 5 practitioners Practice locations: White Bear Lake, MN |
National Provider Directory
Locations
4717 Clark Ave
White Bear Lk, MN 55110
Phone (651) 762-8040
2130 2nd St
White Bear Lk, MN 55110
Phone (651) 762-8040
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4394 | MN | Yes |
Addresses
Primary practice location
4717 Clark Ave
White Bear Lake, MN 55110-3221
Mailing address
4717 Clark Ave
White Bear Lake, MN 55110-3221
Phone (651) 762-8040
Other providers in White Bear Lake, MN
- Maria Isabel Camacho Marrero
- Michael Campfield
- Care Horizon
- Shawna L Carey
- Caring Hands Homecare LLC
- Dustin Paul Carlson
- Nicole G Carlson
- Sara Carlson
- Allison E Carpenter
- Allyson K Caspers
All providers in White Bear Lake, MN · Chiropractor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.