Provider Demographics
NPI:1124094180
Name:DOYLE, DENNIS A (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:DOYLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FINLEY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1721
Mailing Address - Country:US
Mailing Address - Phone:217-243-2776
Mailing Address - Fax:
Practice Address - Street 1:1521D W WALNUT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650
Practice Address - Country:US
Practice Address - Phone:217-243-4333
Practice Address - Fax:217-243-8082
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038004089Medicaid
6982007OtherBLUE CROSS BLUE SHIELD
009747OtherHEALTH ALLIANCE
136765OtherHEALTH LINK
136765OtherHEALTH LINK
T37441Medicare UPIN