Provider Demographics
NPI:1588785034
Name:CARLSON, ELMER J (DC)
Entity type:Individual
Prefix:DR
First Name:ELMER
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:M
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:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0704
Mailing Address - Country:US
Mailing Address - Phone:206-463-3677
Mailing Address - Fax:
Practice Address - Street 1:9722 SW BANK RD.
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-0704
Practice Address - Country:US
Practice Address - Phone:206-463-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0008374OtherDEPT. LABOR & INDUSTRIES
WAT01547Medicare UPIN