Provider Demographics
NPI:1114992419
Name:DOYLE, CODY BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:BLAKE
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:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-0242
Mailing Address - Country:US
Mailing Address - Phone:979-968-6400
Mailing Address - Fax:979-968-6407
Practice Address - Street 1:851 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2361
Practice Address - Country:US
Practice Address - Phone:979-968-6400
Practice Address - Fax:979-968-6407
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350049531OtherRAILROAD MEDICARE
TX605579OtherBLUE CROSS BLUE SHIELD
TX605579Medicare ID - Type Unspecified
TXTXB144333Medicare PIN
TX605579OtherBLUE CROSS BLUE SHIELD