Provider Demographics
NPI:1417029612
Name:COYLE, BRIAN E (DC, FASBE)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:COYLE
Suffix:
Gender:M
Credentials:DC, FASBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 W. HAMILTON AVE. #160
Mailing Address - Street 2:
Mailing Address - City:CAMBPELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0521
Mailing Address - Country:US
Mailing Address - Phone:408-264-6644
Mailing Address - Fax:408-264-3515
Practice Address - Street 1:1711 BRANHAM LN STE A10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-5227
Practice Address - Country:US
Practice Address - Phone:408-264-6644
Practice Address - Fax:408-264-3515
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC151690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0151690Medicare UPIN
CA6090010001Medicare NSC