Provider Demographics
NPI:1093789042
Name:CARLYLE, THOMAS EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:CARLYLE
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 1:611 COURT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5446
Mailing Address - Country:US
Mailing Address - Phone:501-358-4894
Mailing Address - Fax:501-358-4891
Practice Address - Street 1:611 COURT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5446
Practice Address - Country:US
Practice Address - Phone:501-358-4894
Practice Address - Fax:501-358-4891
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY21462OtherMEDICARE PTAN
AR142756718Medicaid
AR5W289Medicare ID - Type Unspecified
AR142756718Medicaid