Provider Demographics
NPI:1548348428
Name:CARLSON, LYNN M (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREAT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5684
Mailing Address - Country:US
Mailing Address - Phone:978-429-8952
Mailing Address - Fax:
Practice Address - Street 1:30 GREAT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5684
Practice Address - Country:US
Practice Address - Phone:978-429-8952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24705111NN0400X
MA2739111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology