Healthcare Provider Details

I. General information

NPI: 1780133439
Provider Name (Legal Business Name): APPLE NEURO AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E MOODY BLVD
BUNNELL FL
32110-5916
US

IV. Provider business mailing address

1400 E MOODY BLVD
BUNNELL FL
32110-5916
US

V. Phone/Fax

Practice location:
  • Phone: 386-313-2599
  • Fax: 386-313-2577
Mailing address:
  • Phone: 386-313-2599
  • Fax: 386-313-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROY C CARLISI
Title or Position: OWNER
Credential: MD
Phone: 386-313-2599