Provider Demographics
NPI:1992980668
Name:CARLSON, PAUL RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RAYMOND
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 GOLDEN SHR
Mailing Address - Street 2:SUITE220
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4214
Mailing Address - Country:US
Mailing Address - Phone:562-310-4592
Mailing Address - Fax:562-310-4592
Practice Address - Street 1:11 GOLDEN SHR
Practice Address - Street 2:SUITE 220
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4214
Practice Address - Country:US
Practice Address - Phone:562-310-4592
Practice Address - Fax:562-310-4592
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13966111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC13966Medicare PIN