Provider Demographics
NPI:1114242617
Name:DOYLE-DALLAS, ANNIE CAILIN (DIPL OM)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:CAILIN
Last Name:DOYLE-DALLAS
Suffix:
Gender:F
Credentials:DIPL OM
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:CAILIN
Other - Last Name:DALLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3418 S EUCALYPTUS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2368
Mailing Address - Country:US
Mailing Address - Phone:480-659-9552
Mailing Address - Fax:
Practice Address - Street 1:3418 S EUCALYPTUS PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2368
Practice Address - Country:US
Practice Address - Phone:480-659-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist