Provider Demographics
NPI:1225217250
Name:CARLISLE, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CARLISLE
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 1:5306 SOUTH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4116
Mailing Address - Country:US
Mailing Address - Phone:704-525-0026
Mailing Address - Fax:704-525-9189
Practice Address - Street 1:5306 SOUTH BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4116
Practice Address - Country:US
Practice Address - Phone:704-525-0026
Practice Address - Fax:704-525-9189
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890827TMedicaid
NC0827MOtherBCBS
NCU68029Medicare UPIN
NC890827TMedicaid