Provider Demographics
NPI:1609903962
Name:DOYLE, MICKY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICKY
Middle Name:ROBERT
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 1:2900 CLEAR ACRE LN STE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1764
Mailing Address - Country:US
Mailing Address - Phone:775-673-6858
Mailing Address - Fax:775-673-6877
Practice Address - Street 1:2900 CLEAR ACRE LN STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1764
Practice Address - Country:US
Practice Address - Phone:775-673-6858
Practice Address - Fax:775-673-6877
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100221Medicare ID - Type Unspecified