MEDICARE: DR. CARLY NEWSOME DC

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	15247	FL

General Provider Information

NPI Number	:	1083436182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLY NEWSOME DC

Provider Business Mailing Address
First Line	:	10961 BURNT MILL RD APT 126
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4674
Country	:	US
Telephone Number	:	904-217-0361
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 VALLEY RIDGE BLVD STE 106
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5173
Country	:	US
Telephone Number	:	904-217-0361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/18/2025

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Directions to “ DR. CARLY NEWSOME DC” Practice Location

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