Provider Demographics
NPI:1447529821
Name:DOYLE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DOYLE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIANM
Authorized Official - Phone:817-767-5430
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-0590
Mailing Address - Country:US
Mailing Address - Phone:817-767-5430
Mailing Address - Fax:817-767-5433
Practice Address - Street 1:295 W BYRON NELSON BLVD STE 212
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3504
Practice Address - Country:US
Practice Address - Phone:817-767-5430
Practice Address - Fax:979-968-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144332Medicare PIN