Provider Demographics
NPI:1740605054
Name:SMART, CARLYLE (DC)
Entity Type:Individual
Prefix:
First Name:CARLYLE
Middle Name:
Last Name:SMART
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 1:372 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1777
Mailing Address - Country:US
Mailing Address - Phone:401-847-2248
Mailing Address - Fax:401-847-5915
Practice Address - Street 1:372 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1777
Practice Address - Country:US
Practice Address - Phone:401-847-2248
Practice Address - Fax:401-847-5915
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009268111N00000X
RIDCP00636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor