Provider Demographics
NPI:1336265842
Name:DOYLE, EDWIN S (DC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:S
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 1:900 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-4703
Mailing Address - Country:US
Mailing Address - Phone:217-243-2225
Mailing Address - Fax:
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-4703
Practice Address - Country:US
Practice Address - Phone:217-243-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor