Provider Demographics
NPI:1801084058
Name:CARLYLE, PHILLIP E (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:E
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 1:50 AVIATOR PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-0140
Mailing Address - Country:US
Mailing Address - Phone:912-638-5909
Mailing Address - Fax:912-638-3153
Practice Address - Street 1:50 AVIATOR PLZ STE 102
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-0140
Practice Address - Country:US
Practice Address - Phone:912-638-5909
Practice Address - Fax:912-638-3153
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU75903Medicare UPIN
GA35ZCGMNMedicare PIN