Provider Demographics
NPI:1538269162
Name:ATHERTON, DEANNA CARLISLE (DC)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:CARLISLE
Last Name:ATHERTON
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 1:152 N HARBOR CITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6794
Mailing Address - Country:US
Mailing Address - Phone:321-255-0010
Mailing Address - Fax:321-255-0044
Practice Address - Street 1:152 N HARBOR CITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6794
Practice Address - Country:US
Practice Address - Phone:321-255-0010
Practice Address - Fax:321-255-0044
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB872OtherMEDICARE GROUP NO.
FL55726OtherBC/BS
FL350050517OtherRAILROAD MEDICARE
1659597623OtherGROUP NPI
AB872OtherMEDICARE GROUP NO.