Provider Demographics
NPI:1811916000
Name:COYLE CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:COYLE CHIROPRACTIC CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-264-6644
Mailing Address - Street 1:3315 ALMADEN EXPY STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1557
Mailing Address - Country:US
Mailing Address - Phone:408-264-6644
Mailing Address - Fax:408-264-3515
Practice Address - Street 1:3315 ALMADEN EXPY STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1557
Practice Address - Country:US
Practice Address - Phone:408-264-6644
Practice Address - Fax:408-264-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20945111N00000X
CA20A6277207R00000X
CADC15169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15169OtherSTATE LICENSE NUMBER
CADC20945OtherSTATE LICENSE NUMBER
CADC15169OtherSTATE LICENSE NUMBER
CAZZZ04409ZMedicare PIN