MEDICARE: CARLISLE CHIROPRACTIC CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH7519	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55726	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1659597623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLISLE CHIROPRACTIC CENTER, INC.

Provider Business Mailing Address
First Line	:	1900 S HARBOR CITY BLVD
Second Line	:	#109
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4749
Country	:	US
Telephone Number	:	321-724-0579
Fax Number	:	321-724-9788

Provider Business Practice Location Address
First Line	:	1900 S HARBOR CITY BLVD
Second Line	:	#109
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4749
Country	:	US
Telephone Number	:	321-724-0579
Fax Number	:	321-724-9788

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEANNA RUTH CARLISLE
Credential	:	D.C.
Telephone Number	:	321-724-0579

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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