Provider Demographics
NPI:1134161250
Name:CARLE, KENNETH DOUGLAS (DC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DOUGLAS
Last Name:CARLE
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 1:5664 BEE RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1504
Mailing Address - Country:US
Mailing Address - Phone:941-379-2737
Mailing Address - Fax:941-379-2738
Practice Address - Street 1:5664 BEE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1504
Practice Address - Country:US
Practice Address - Phone:941-379-2737
Practice Address - Fax:941-379-2738
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor