Provider Demographics
NPI:1447433834
Name:CARLSON, DIANE KRISTY (DC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:KRISTY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W STATE ROUTE 89A UNIT 10580
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-6135
Mailing Address - Country:US
Mailing Address - Phone:928-862-4333
Mailing Address - Fax:928-862-4334
Practice Address - Street 1:2530 W STATE ROUTE 89A STE B1
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5259
Practice Address - Country:US
Practice Address - Phone:928-862-4333
Practice Address - Fax:928-862-4334
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor