Provider Demographics
NPI:1154696805
Name:CARSON, JENNIFER (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 WITHERSPOON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6844
Mailing Address - Country:US
Mailing Address - Phone:270-293-2683
Mailing Address - Fax:
Practice Address - Street 1:3519 WITHERSPOON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6844
Practice Address - Country:US
Practice Address - Phone:270-293-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor