Carlyle Chiropractic Clinic P.C.
Organization Active NPI Chiropractor · St Simons Island, GA
NPI 1801816178 · NPPES record last updated Jul 18, 2022
Key facts
- NPI
- 1801816178
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 006353 (GA)
- Legal business name
- CARLYLE CHIROPRACTIC CLINIC P.C.
- Practice address
- 50 Aviator PLZ Ste 102
St Simons Island, GA 31522-0140 - Phone
- (912) 638-5909
- Fax
- (912) 638-3153
- NPI assigned
- Jul 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Phillip E Carlyle, DC
- Title
- DC
- Phone
- (912) 638-5909
Practitioners 2
-
Brent J Deshaw, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080213000435 | GA | Part B Supplier - Clinic/Group Practice | 6204919335 |
Receives reassigned benefits from 1 practitioner Practice locations: Saint Simons Island, GA |
National Provider Directory
Locations
207 Edwards Plz
St Simons Island, GA 31522
Phone (912) 638-5909
50 Aviator Plz
Ste 102
St Simons Island, GA 31522
Phone (912) 638-5909
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 006353 | GA | Yes |
Addresses
Primary practice location
50 Aviator PLZ Ste 102
St Simons Island, GA 31522-0140
Mailing address
50 Aviator PLZ Ste 102
St Simons Island, GA 31522-0140
Phone (912) 638-5909
Other practice location 1
207 Edwards Plaza
St. Simons Island, GA 31522
Phone (912) 638-5909
Other providers in St Simons Island, GA
- Anna Marie Cabeca
- Ashley Neal Callicutt
- Sage LM Campione
- Jeffrey Oliver Capes
- Mary Jean Cardin
- Phillip E Carlyle
- Amber Carter
- Margaret Furey Carter
- Monica Sutton Carter
- Ashley C Cavalier
All providers in St Simons Island, GA · Chiropractor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.