Provider Demographics
NPI:1104948744
Name:CARSON, CHRIS WILLIAM (LMP, MMP)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:WILLIAM
Last Name:CARSON
Suffix:
Gender:M
Credentials:LMP, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 W RIVERSIDE AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1104
Mailing Address - Country:US
Mailing Address - Phone:509-939-4184
Mailing Address - Fax:
Practice Address - Street 1:1002 W RIVERSIDE AVE
Practice Address - Street 2:STE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1104
Practice Address - Country:US
Practice Address - Phone:509-939-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist