Provider Demographics
NPI:1144239062
Name:COYLE, EDWARD SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:COYLE
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 1:1820 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1709
Mailing Address - Country:US
Mailing Address - Phone:785-856-7600
Mailing Address - Fax:785-856-7511
Practice Address - Street 1:1820 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1709
Practice Address - Country:US
Practice Address - Phone:785-856-7600
Practice Address - Fax:785-856-7511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1148999Medicaid
U54328Medicare UPIN
IAU54328Medicare UPIN
IA46248Medicare PIN