Provider Demographics
NPI:1952552069
Name:CARLILE CHIROPRACTIC LLC.
Entity Type:Organization
Organization Name:CARLILE CHIROPRACTIC LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:CARLILE
Authorized Official - Suffix:
Authorized Official - Credentials:BSDC
Authorized Official - Phone:907-374-9331
Mailing Address - Street 1:PO BOX 70690
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0690
Mailing Address - Country:US
Mailing Address - Phone:907-474-9331
Mailing Address - Fax:907-374-9276
Practice Address - Street 1:1222 WELL ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-2835
Practice Address - Country:US
Practice Address - Phone:907-374-9331
Practice Address - Fax:907-374-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty