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General NPI Number Information
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NPI Number | 1033481379
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Entity Type | Individual
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Provider Name | DAVE JAY COYNE L.AC.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 222 S 1ST ST 102
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City | LOUISVILLE
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State | KY
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Zip | 40202-5404
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Country | US
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Telephone | 619-723-1540
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Fax |
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Provider Business Mailing Address
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Address Line | 401 SHELDON AVE
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City | COLUMBUS
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State | OH
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Zip | 43207-1257
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Country | US
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Telephone | 619-723-1540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 65.000205
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | TAC56
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License Number State | KY
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