Provider Demographics
NPI:1316957186
Name:CARLILE, JONATHAN STEPHEN SR (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STEPHEN
Last Name:CARLILE
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:STEPHEN
Other - Last Name:CARLILE
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:416 7TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4932
Mailing Address - Country:US
Mailing Address - Phone:907-978-9791
Mailing Address - Fax:
Practice Address - Street 1:416 7TH AVE STE A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4932
Practice Address - Country:US
Practice Address - Phone:907-978-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor