Provider Demographics
NPI:1366451288
Name:CARLSTROM, CHRISTIAN B (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:B
Last Name:CARLSTROM
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 1:1102 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6813
Mailing Address - Country:US
Mailing Address - Phone:561-741-1316
Mailing Address - Fax:561-741-1375
Practice Address - Street 1:1102 W INDIANTOWN RD
Practice Address - Street 2:SUITE 11
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6813
Practice Address - Country:US
Practice Address - Phone:561-741-1316
Practice Address - Fax:561-741-1375
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381212000Medicaid
FLCH7662OtherSTATE LICENSE
FL55871YMedicare PIN
FLK1301Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL381212000Medicaid