Provider Demographics
NPI:1255490454
Name:DOYLE, JACQUELIN A (LAC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELIN
Middle Name:A
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-985-1344
Mailing Address - Fax:215-985-1434
Practice Address - Street 1:1004 PINE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-985-1344
Practice Address - Fax:215-985-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000026L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist