Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 08002401A | IN |
NPI | 1003068354 |
---|---|
Provider Name | Dr. Joel Matthew Carson |
First Address | Indianapolis, IN 46214-5702 |
Second Address | Indianapolis, IN 46214-5702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2008 |
Last Update Date | 19/01/2017 |