Provider Demographics
NPI:1033481379
Name:COYNE, DAVE JAY (LAC)
Entity type:Individual
Prefix:MR
First Name:DAVE
Middle Name:JAY
Last Name:COYNE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:COYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 SHELDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1257
Mailing Address - Country:US
Mailing Address - Phone:619-723-1540
Mailing Address - Fax:
Practice Address - Street 1:222 S 1ST ST
Practice Address - Street 2:102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5404
Practice Address - Country:US
Practice Address - Phone:619-723-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000205171100000X
KYTAC56171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist