Provider Demographics
NPI:1700974359
Name:COYLE, CURTIS (DC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
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 1:101 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1252
Mailing Address - Country:US
Mailing Address - Phone:815-625-4790
Mailing Address - Fax:
Practice Address - Street 1:1809 LOCUST ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1101
Practice Address - Country:US
Practice Address - Phone:815-622-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL078540OtherHEALTH ALLIANCE MEDICAL
IL9815737OtherBLUE CROSS BLUE SHIELD
IL9815737OtherBLUE CROSS BLUE SHIELD
IL3500054768Medicare ID - Type UnspecifiedRAILROAD MEDICARE