# CARLSON CHIROPRACTIC CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Philip Carlson, D.C.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205203197
- **Authorized official:** DR. PHILIP JOHN CARLSON D.C. (OWNER)
- **Authorized official phone:** (715) 223-1511

## Contact information

- **Practice address:** 111 S. FIRST STREET, COLBY, WI 54421-0026
- **Practice address phone:** (715) 223-1511
- **Practice address fax:** (715) 223-1411
- **Mailing address:** P.O. 26, 111 S. FIRST STREET, COLBY, WI 54421-0026
- **Mailing address phone:** (715) 223-1511
- **Mailing address fax:** (715) 223-1411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 3466-12 | WI | Yes |

## Other

- **Enumeration date:** 08/26/2015
- **Last updated:** 08/26/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 38904300 | — | WI |