=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447529821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOYLE CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2011
-----------------------------------------------------
Last Update Date | 09/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 295 W BYRON NELSON BLVD STE 212
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76262-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-767-5430
-----------------------------------------------------
Fax | 979-968-6407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 590
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76262-0590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-767-5430
-----------------------------------------------------
Fax | 817-767-5433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | DR. CODY B DOYLE
-----------------------------------------------------
Credential | DC, DIANM
-----------------------------------------------------
Telephone | 817-767-5430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------