Provider Demographics
NPI:1316056435
Name:CARLILE, CARMEN NAREZO (DC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:NAREZO
Last Name:CARLILE
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 1:8647 WURZBACH BLDG H
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1245
Mailing Address - Country:US
Mailing Address - Phone:210-641-6355
Mailing Address - Fax:210-641-7009
Practice Address - Street 1:8647 WURZBACH BLDG H
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1245
Practice Address - Country:US
Practice Address - Phone:210-641-6355
Practice Address - Fax:210-641-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608581OtherBCBS
TX441425Medicare PIN
TXU14182Medicare UPIN
TXU14182Medicare UPIN