Provider Demographics
NPI:1154105849
Name:CARLSON, ISAAC (DC)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:CARLSON
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 AUDEN DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63341-1405
Mailing Address - Country:US
Mailing Address - Phone:636-439-8411
Mailing Address - Fax:
Practice Address - Street 1:249 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2497
Practice Address - Country:US
Practice Address - Phone:636-256-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025004801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor