Provider Demographics
NPI:1083436182
Name:NEWSOME, CARLY (DC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 BURNT MILL RD APT 126
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4674
Mailing Address - Country:US
Mailing Address - Phone:386-316-7344
Mailing Address - Fax:
Practice Address - Street 1:10961 BURNT MILL RD APT 126
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4674
Practice Address - Country:US
Practice Address - Phone:386-316-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor