Healthcare Provider Details

I. General information

NPI: 1093789042
Provider Name (Legal Business Name): THOMAS EDWARD CARLYLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COURT ST SUITE 4
CONWAY AR
72032-5446
US

IV. Provider business mailing address

611 COURT ST SUITE 4
CONWAY AR
72032-5446
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-4894
  • Fax: 501-358-4891
Mailing address:
  • Phone: 501-358-4894
  • Fax: 501-358-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1569
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: