Provider Demographics
NPI:1952310609
Name:CARLYLE, WARREN K (DC)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:K
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 1:3181 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2186
Mailing Address - Country:US
Mailing Address - Phone:352-338-0095
Mailing Address - Fax:352-373-2444
Practice Address - Street 1:3181 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2186
Practice Address - Country:US
Practice Address - Phone:352-338-0095
Practice Address - Fax:352-373-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89081OtherBC BS FL
FL89081OtherBC BS FL
FL89081Medicare PIN